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Full text of "The 1962 Annual Report of the Children's Hospital Medical Center"

THE CHILDREN'S HOSPITAL MEDICAL CENTER 



1962 Annual Report 




THE 1962 ANNUAL REPORT 




CHILDREN'S HOSPITAL MEDICAL CENTER 

comprising: 

Association of the House of the Good Samaritan 

Sarah Fuller Foundation for Little Deaf Children 

The Sharon Sanatorium 

The Hospital and Convalescent Home for Children 

and affiliates: 

Children's Cancer Research Foundation, Inc. 

Judge Baker Guidance Center 

The Children's Mission to Children 

300 LONGWOOD AVENUE, BOSTON 15 



By 1968, C. H. M. C will resemble this an ith new 

buildings in the main cluster ck 

general services. Parking facility and housing center (in Br. 
Avenue (upper rid ity. 




OFFICERS, BOARD OF TRUSTEES, 1963 



William W. Wolbach 

PRESIDENT 

G. Peabody Gardner 

VICE PRESIDENT 

Alexander Wheeler 

VICE PRESIDENT 

F. Murray Forbes, Jr. 

TREASURER 

Arnold W. Hunnewell 

SECRETARY AND ASSISTANT TREASURER 

Mrs. David Wilder 

CHAIRMAN, WOMEN'S COMMITTEE 

Nelson S. Bartlett, Jr. 

ASSISTANT TREASURER 



(OF THE CHILDREN'S MEDICAL CENTER 




THE CHILDREN'S HOSPITAL MEDICAL CENTER 



Chiefs of Staff, 1963 

Charles Barlow, M.D. 

NEUROLOGIST-IN -CHIEF 
Sidney Farber, M.D. 

PATHOLOGIST-IN-CHIEF 

George E. Gardner, M.D. 

PSYCHIATRIST-IN-CHIEF 
William T. Green, M.D. 

ORTHOPEDIC SURGEON-IN-CHIEF 

Robert E. Gross, M.D. 

SURGEON-IN-CHIEF 

Charles A. Janeway, M.D. 

PHYSICIAN-IN -CHIEF 

Donald D. Matson, M.D. 

ACTING NEUROSURGEON-IN-CHIEF 

Edward B. D. Neuhauser, M.D. 

RADIOLOGIST-IN-CHIEF 



Administrative Staff, 1963 



GENERAL DIRECTOR 

Leonard W. Cronkhite, Jr., M.D. 

ASSISTANT TO THE 
GENERAL DIRECTOR 

Lendon Snedeker, M.D. 

DIRECTOR OF NURSING 

Muriel B. Vesey, R.N. 

DIRECTOR OF FISCAL AFFAIRS 
AND CONTROLLER 

Richard E. Held, C.P.A. 

DIRECTOR OF PERSONNEL 

Alexander T. Brown 

DIRECTOR OF GENERAL SERVICES 
Rudman J. Ham 

DIRECTOR OF PUBLIC RELATIONS 

William J. Brennan 



FUND DIRECTOR 

Mrs. Anthony T. Michaels 

ADMINISTRATIVE ASSISTANT 
TO THE GENERAL DIRECTOR 

John A. Lombardo 

ADMINISTRATIVE ASSISTANT 
TO THE GENERAL DIRECTOR 

Richard Bertocchi 



ASSISTANT SECRETARY OF THE BOARD 
Miss Antoinette J. Valenza 

COUNSEL 

William N. Swift 
AUDITORS 

Arthur Andersen & Co. 



By 1975, C. H. M. C. will stretch from Brookline Avenue to Harvard Medical School. New buildings 
will house activities formerly carried out in Building A and in former apartment buildings along Longwood 
Avenue. This is Children's proposed "new face to the pediatric world of the future." 




THE CHILDREN'S HOSPITAL MEDICAL CENTER 



ADMINISTRATIVE STAFF, 1963, continued 



Faculty, School of Nursing 

ASSOCIATE DIRECTOR 

Miss Ethel Trafton 

CHAIRMAN, CHILDREN'S HOSPITAL PROGRAM 

Miss Olive Simard 

CHAIRMAN, AFFILIATE PROGRAM 

Miss Rita Bryant 



Nursing Service Staff 

ASSOCIATE DIRECTOR 
Mrs. Phyllis G. Downing 

ASSISTANT DIRECTORS 

Miss M. Aldra Dickie, Evening 
Miss Lorene Dresser, Day 
Miss Dorothy Pratt, Out-Patient 
Miss Lydia Smith, Night 

SUPERVISORS AND INSTRUCTORS 

Miss Brooks Barnes, Medical 

Miss Edith Bell, Central Services 

Mrs. Grace Bennett, Supplies and Equipment 

Mrs. Janice Christensen, Evenings 

Miss Marilyn Coco, Operating Rooms 

Miss Jeanne Colt, Surgical 

Miss Margaret Francis, Good Samaritan and 

Respirator Unit 
Miss Joan Gassman, Orthopedic 
Mrs. Lois Morgan, Acting Director, Education 
Mrs. Caroline Overfors, Private 
Mrs. Marion Stewart, Instructor 



Heads of Administrative Services 

OFFICE MANAGER, ACCOUNTING DEPARTMENT 

Mrs. Laura Bocon 

SENIOR RECEPTIONIST 
Mrs. Grace Bradley 

SUPERVISOR, PRINT SHOP 

Salvatore Caliguri 

DIRECTOR, PHYSICAL THERAPY DEPARTMENT 

Miss Shirley Cogland 

SUPERVISOR, MAIL ROOM 

Theodore Cranton 

SECRETARY, WOMEN'S COMMITTEE 

Mrs. Jose R. Cruz 



CHIEF TELEPHONE OPERATOR 

Miss Josephine Daley 

PURCHASING AGENT 
Miss Elizabeth Fitzgerald 

DIRECTOR, HEALTH EDUCATION 

Mrs. Harriet H. Gibney 

DIRECTOR, DIETARY DEPARTMENT 

Miss Maxine Gilson 

MANAGER, SURGICAL APPLIANCE SHOP 

John Glancy 

DIRECTOR, VISUAL EDUCATION DEPARTMENT 

F. R. Harding 

DIRECTOR, VOLUNTEER SERVICE 
Mrs. Kathleen Higgins 

ASSISTANT CONTROLLER 

Benjamin Jurcik, C.P.A. 

MANAGER, HOUSEKEEPING 

Lawrence Levinson 

DIRECTOR, MEDICAL RECORDS DEPARTMENT 

Mrs. Corinne Norton 

DIRECTOR, EMPLOYEE HEALTH SERVICE 

Miss Hester E. Macuen, R.N. 

DIRECTOR, SOCIAL SERVICE 
Miss Elizabeth Maginnis 

MANAGER, DATA PROCESSING 

Webster McKnight 

MANAGER, METHODS AND FORMS CONTROL 
Miss Margaret Meenan 

MANAGER, SPECIAL SERVICES 

George T. Nicoll 

COORDINATOR, DEPARTMENT OF 
PATIENT EDUCATION AND RECREATION 

Mrs. Barbara Patterson 
PLANT SUPERINTENDENT 

George Stilgoe 

ENGINEER FOR PLANNING AND CONSTRUCTION 

Arthur Stomberg 
CHIEF PHARMACIST 

Arthur M. Thompson 




THE PRESIDENT'S REPORT 

All great institutions go through periods during which critical exam- 
ination of objectives and methods of achieving them is essential to con- 
tinued progress and good health. The past year has been such a period 
in the administration of The Children's Hospital Medical Center. In 
1962, the Board of Trustees, Administration, and Staff took a series of 
decisive steps to put our vast house in order for an intensified program 
of growth and development of our services to children. The steps, fruit- 
ful in their promise of future progress, were in reality the beginning of 
a planning and expansion program to be climaxed with the celebration 
of our One-Hundredth Anniversary in 1969. We have the first state- 
ment of this program in the General Director's Report on pages 9 to 16. 

While we have continued to take great pride in the quality and 
professional leadership in the principal functions of the Medical Center — 
patient care, teaching, and research — there has been growing concern 
over the declining use of certain of our facilities, resulting, among 
other things, in the substantial and mounting deficits. Thus the question 
has arisen as to whether the Medical Center as a total concept was 
keeping abreast of the needs of the community and of accelerating changes 
in medicine in general. This last statement should in no way be construed 
as reflecting upon our Staff. They simply cannot be expected to have 
the time, on top of their already rigorous schedules, to do the planning, 
developing, coordinating, and expediting of the plans and policies neces- 
sary to keep the Medical Center, as a total enterprise, in the vanguard 
of progress. 

The problem essentially has been one of leadership — and leadership 
is an extraordinarily difficult commodity to provide for hospitals and 
particularly teaching hospitals. 

To begin with, the organizational structure of voluntary hospitals is 
peculiarly complex and, to my way of thinking, thoroughly unsatisfac- 
tory from the standpoint of clear-cut responsibility and control. Tra- 
ditionally and properly the Trustees are charged with the final responsi- 
bility; and in some cases — particularly in smaller community hospitals 
which cannot afford more than a one- or two-man administrative staff — 
Trustees become actively involved in many phases of management. As 
the group responsible for patient care, the professional Staff is given 
full authority over all medical matters, and this is also as it should be. 
However, the dividing line as to where medical responsibility leaves off 
and that of the administrator begins can be blurred almost to the point 
of invisibility, leaving the latter in the position of business administrator, 
housekeeper, general-purpose prat-boy and fall-guy and without sufficient 
authority to carry out adequately even this dubious collection of duties. 
How forward planning and executive leadership can flourish in an 
organizational environment such as this is an excellent question — it is 
certainly doing it the hard way! Small wonder that the average term 
of office of a hospital administrator is scarcely longer than the com- 
parable expectancy of a major league baseball manager. 

It is the writer's strong feeling that this traditional "troika" system 
of organization control of hospitals is inadequate for a major teaching 
and research center such as ours. To begin with, the complexity and 
subtleties are so overwhelming as to provide the supreme test for the 
ablest of executives even though he be provided with virtually dictatorial 
authority. Furthermore, in addition to the Trustees, here is an incom- 
plete list of those with whom the General Director of the Medical 
Center must work — usually as THE HOSPITAL, but other times as 



the official representative of the Trustees: 

the Medical Staff, including the senior staff with tenure 

our own assistant administrators 

non-medical employees 

the Dean of the Harvard Medical School 

administrators of other hospitals 

patients and their relatives 

various branches and instruments of Federal, State, and 
Municipal governments 

medical and other scientific foundations 

architects and contractors 

the press and public 
It seems almost axiomatic that no Director, however capable, can 
operate effectively in an atmosphere such as this unless he is recognized 
as a professional equal by the senior staff and is given authority and 
backing by the Trustees comparable to those of the chief executive officer 
in a business enterprise. 

Until now this has not been the case. Whereas the Hospital has 
been characterized by preeminently strong professional leadership in 
its several major Services, it has not emphasized strong administration. 
Decentralization of authority has ensured a maximum of individual 
creative freedom for the Staff, but has not developed a total organiza- 
tional structure which can be quickly responsive to social and economic 
change and to today's rapid technological advances in the biological 
sciences. 

With this general background, it can be stated that the most impor- 
tant forward step taken in 1962 was the selection of the new General 
Director. The appointment of Dr. Leonard W. Cronkhite, Jr., has given 
to the Trustees and Staff a thoroughly revitalizing experience, bringing 
as he did outstanding abilities and the background of a rich and varied 
career. Furthermore, Dr. Cronkhite is operating under a broad dele- 
gation of authority from the Trustees which can be summarized as 
follows : 

to serve as the chief executive officer of The Children's Hospital 

Medical Center. 

to provide leadership in the conception, development, and execu- 
tion of its objectives, policies, plans, and programs 

to direct its total professional and business affairs 
In scarcely over a year, Dr. Cronkhite has given the Medical Center 
an almost incredible amount of forward momentum on many fronts. 
In keeping with the highest traditions of administrative leadership, he 
has achieved this by hard work, clear thinking, reliance on competent 
advice, and the persuasiveness of irrefutable logic. He commands the 
full backing of the Board of Trustees and has earned the respect and 
cooperation of the Staff. 

As the preceding paragraphs must undoubtedly suggest, I believe 
that the problems and complexities of the modern teaching hospital 
require a different organizational concept than has traditionally pre- 
vailed. This new concept presumes, above all else, a chief executive 
officer of superior capabilities and provided with adequate scope and 
authority to carry out the awesome responsibilities entrusted to him. 
The Medical Center has adopted this as a plan of basic policy and 
is confident that it represents a significant turning point in its de- 
velopment. 

William W. Wolbach, President 



TREASURER'S REPORT 

In 1962, although revenue from services to patients increased 11 per 
cent over the previous year, the continuing higher cost of providing such 
services resulted in the highest deficit in the history of the Hospital: 
$869,000 before depreciation, compared to $645,000 in 1961. As shown 
in the comparative statement of income, the net loss after depreciation 
was $1,308,000 in 1962 and $1,078,000 in 1961. 

The increase of $223,000 in the deficit is accounted for by these 
changes: 

Increase in net operating expenses $730,000 

Increase in patient allowances and adjustments 152,000 

Less: Increase in patient revenue $580,000 $882,000 

Increase in other revenue 79,000 659,000 

Increase in loss, before depreciation $223,000 

The increase in patient revenue reflects greater utilization of the 
Hospital — patient occupancy of the 3 50 bed capacity was 73 per cent in 
1962 compared to 69 per cent in 1961 (complete patient statistics for 
both years are shown on page 8 ) . Revenue from day rate services in- 
creased $320,000 due to higher occupancy and to the increase in the 
board rate of $2.00 per day, effective May 1, 1962. Ancillary and clinic 
revenue increased $260,000. A substantial portion of the latter is due 
to revisions in the ancillary rate structure, in line with other institutions, 
initiated in the fourth quarter of the year. These are the major revenue 
changes recommended in the Controller's divisional cost report of 1961, 
and it is estimated that, based on 1962 occupancy and utilization, the 
special service revenue in 1963 will be increased by $200,000. 

Since in both 1962 and 1961, net operating expenses exceeded patient 
revenue by 20 per cent, the additional revenue from the above sources 
merely defrayed the current increases in salary and expenses. Therefore, 
in 1963, major efforts will be directed toward raising occupancy in order 
to substantially reduce the deficit. This is essential because it is obvious 
that deficits of the magnitude of those incurred in the last two years 
deplete legacy and endowment funds contributed to provide for free 
patient care. 

F. MURRAY FORBES, JR., Treasurer 



THE CHILDREN'S HOSPITAL MEDICAL CENTER 

Comparative Statement of Income for the Years Ended September 30, 1962 and 1961 

1962 1961 

During the year we earned from: 

Day-rate services to inpatients $2,750,508 $2,429,211 

Special (ancillary) services to: 

Inpatients $1,762,694 $1,540,239 

Outpatients 560,741 519,766 

Other organizations 100,179 2,423,614 130,980 2,190,985 

Outpatient clinic fees '. . . . 446,964 420,800 

Total patient revenue " . . . $5,621,086 $5,040,996 

Because of contractual arrangements and 
patients' inability to pay, we issued: 

Rate adjustments to Blue Cross $159,284 $132,772 

Rate adjustments to welfare agencies 213,678 179,643 

Allowances to patients 393,477 333,787 

Account write-offs, net 157,240 923,679 125,026 771,228 

Net patient revenue $4,697,407 $4,269,768 

We spent or incurred for: 

Patient care— salaries $ 4,583,887 $ 4,143,695 

Patient care— expenses 2,780,745 $7,364,632 2,391,286 $6,534,981 

Research and education — salaries and expenses $ 1,973,092 $ 1,793,462 

Supported by grant income of $(1,973,092 ) $(1,793,462 ) 

Less revenue received for: 

General services, dietary, School of Nursing, etc $443,218 $395,259 

Overhead from grants 156,330 599,548 104,430 499,689 

Net operating expenses $6,765,084 $6,035,292 

Since patient revenue did not equal expense, the operating LOSS was . . $2,067,677 $1,765,524 

This operating loss was partially defrayed by income from: 

United Community Services $ 41,309 $ 34,064 

Permanent Charity Fund 31,000 25,560 

Investments and trust funds 833,630 798,658 

Allotments from affiliates 188,121 164,808 

Patient care funds 104,575 96,840 

Total other income 1,198,635 1,119,930 

Net LOSS before depreciation $ 869,042 $ 645,594 

Depreciation: 

Building $292,965 $293,389 

Equipment 146,464 439,429 139,079 432,468 

Net LOSS for fiscal year charged to General Fund $1,308,471 $1,078,062 

This statement of income has been condensed from the annual reoort of our auditors. Arthur Andersen & Co. 



8 



THE CHILDREN'S HOSPITAL MEDICAL CENTER 

Patient Statistics — Comparative Fiscal Years 1962 and 1961 

INPATIENT 



Short-term divisions 
(300 beds) 

Long-term divisions 
(50 beds) 

Total Hospital 
(350 beds) 



Admissions 


Patient 


Days 


Average Length 
of Hospitalization 
(Number of Days) 


Per Cent of 
Beds Occupied 


962 1961 


1962 


1961 


1962 


1961 


1962 1961 


,451 8,848 


80,305 


76,690 


7.5 


7.7 


73.3 70.0 


172 150 


12,535 


11,639 


37.3 


38.4 


68.6 63.8 



9,623 



8,998 



92,840 



88,329 



9.6 



9.8 



72.7 



69.1 



OUTPATIENT 

Clinic visits 

SPECIAL SERVICES 

Laboratory tests 

X-rays 

Operations 

Electrocardiology treatments 

X-ray therapy treatments 

Physical therapy treatments 



1962 


1961 


113,104 


104,412 


1962 


1961 


156,100 


140,950 


86,400 


81,378 


5,513 


5,374 


3,526 


4,006 


3,049 


2,728 


28,997 


26,804 



GENERAL DIRECTOR'S REPORT 




In 1969 The Children's Hospital will celebrate its One-Hundredth 
Anniversary. It is desirable that we have something to celebrate; ideally, 
a program born out of solution of present problems and plans for the 
future, as well as out of a distinguished past. Today's problems require 
precise definition in order to provide for rational formulation of plans 
for the future. Our attention this year has been focused on the several 
broad areas of professional, administrative, and social concern which, 
when compounded, form the heart of the present dilemma. 

The phenomenon of upward spiralling costs is, of course, not pecul- 
iar to The Children's Hospital. As reported by the American Hospital 
Association, the cost of operating all American hospitals rose nearly one 
billion dollars, or about ten per cent, from 1960 to 1961. The upward 
trend having been consistent for several years, we may assume a similar 
future increase. 

The Children's Hospital traditionally has operated at some deficit. 
Indeed, there are those who hold that it is only right and proper for a 
charitable institution to do so. In a way, the Hospital has known where 
the money was coming from, inasmuch as it has been the beneficiary 
of a Boston philanthropy which few other communities could equal. 
The support given the C. H. M. C. by its Trustees, Corporation Members, 
and friends has been magnificent. The Hospital likewise has benefited 
from wise investment counsel, so that its endowment fund and income 
have continued to appreciate in value, although operating deficits have 
been made up out of capital funds as necessary. Conceding that some 
operating loss is inevitable as long as we provide free care for those chil- 
dren whose parents cannot afford to pay (an essential altruism to which 
our Staff and Trustees have always agreed) , it is nonetheless apparent that 
since 1960 the deficit has reached runaway proportions. 

There is no reason for believing that private philanthropy will con- 
tinue undiminished in the form of the past. There are cogent reasons 
for believing that this form of philanthropy, stemming out of large 
personal fortunes, will diminish under the dissecting knife of taxation. 
Thus, the solution to today's financial dilemma is not the wistful hope 
for another increment of public generosity on a continuing basis. It 
must come from a very much more candid appraisal of the fundamental 
problems which beset all hospitals. 

Management 

The usual approach to the costs-versus-revenue line is the employ- 
ment of various managerial techniques borrowed from industry and other 
health agencies. While we do not minimize the value of these purely 
administrative devices, the possibilities of making ends meet by pursuit of 
a variety of small gains in a plant employing 1,400 persons, occupying 
twenty-two buildings, and covering 467,000 square feet of space have a 
limited range. This approach, however vigorously pursued, cannot by 
itself solve our basic operational and economic problem. 

Utilization 

Not too many years ago the Hospital was plagued by the chronic 
problem of an insufficient bed complement to handle the demands made 
upon it for care. But, during the past few years, the problem has been 
over-resolved to the extent that the lower rate of utilization of the 
vast facilities of the Hospital has seriously affected its fiscal health. 
Two aspects of this phenomenon might have been anticipated. On the 
one hand, a well-documented and gratifying shift from hospitalization 
to ambulatory care has occurred in the management of the sick child. 
This in itself provides the Staff with a happy reflection of its many 



10 



efforts to solve the biological riddle of illness. On the other hand, the 
same forces have combined to shorten the hospital stay of each patient, 
which again provides another measure of the very real progress in medi- 
cal care which has taken place in the last decade. 

This triad of low utilization, increase in ambulatory care, and shorter 
hospital stay might lead one erroneously to the conclusion that the many 
services provided by the Hospital in the past are no longer needed in the 
same quantity as before. Indeed, a prudent manager, unwilling to carry 
the analysis any further, would be forced to conclude that the Hospital 
should contract rather than expand its operations. Here, however, a 
paradox is introduced which effectively negates such a simple conclusion. 

While our over-all rate of utilization remains low, some departments 
face the enormous task of catching up on huge waiting lists of patients 
needing highly specialized care. Others, even as this report is being 
written, are successfully translating basic research into techniques which 
promise cure or relief for the sick child. In short order such translations 
create a whole new set of clinical demands on the Hospital which some- 
how must be met within the framework of its operational capacities. 
It is clearly evident, then, that problems in child health present patterns 
of change which resist compression into the rigid professional, admin- 
istrative, or even architectural forms of past years. The Hospital must 
maintain a position of enlightened flexibility which will allow it to 
adjust to the products of its own scientific endeavors and to those of 
other medical centers. It must recognize and acknowledge the change 
in locus of the many kinds of medical procedures: from university 
hospital, to community hospital, to physician's office, and to the home. 
And finally, it cannot fail to be responsive to the very same scientific 
and social changes which it is dedicated to produce. 

If an institution can wisely review its patterns of patient care, its 
professional and administrative organization, and its physical facilities, 



Second Major Development Phase 
calls for replacement of present 
Longwood Avenue buildings with 
complex architecturally harmonious 
and continuous with earlier phase 
construction. 




it will meet the needs of the community it serves, however denned. Full 
utilization of services then becomes a prized by-product to the solution 
of much more fundamental issues. 

During 1962 the Trustees, medical Staff, and administrative staff 
have attempted to come to grips with these basic issues and to develop 
their clear definition. Today we begin to see some solutions — jointly 
conceived, acceptable to most, and exciting in prospect. 




Facilities 

The most charitable thing that can be said about hospital buildings 
is that they are reflections of both the social and medical mores of the 
year in which they were designed, as well as of the financial expediencies 
of the time. It is not surprising that we are heirs to an extraordinary 
heterogeneity of architectural form, size, shape, function, and character. 
Some of these buildings impress one by their beauty of style and execu- 
tion, others by their functional utility, and still others by their total 
inadequacy as parts of a modern hospital. 

One further concern relating to the Hospital's economic problems 
is the possession of structures designed for the practice of medicine as 
conceived in another era. In some instances it is virtually impossible to 
provide a high level of patient care without incurring a substantial 
operating loss. The very fact that C. H. M. C. owns twenty-two struc- 
tures poses an economic problem in itself. It is thus expected that any 
design for the future must include the consolidation and redesign of 
several existing structures, as well as new considerations for new purposes. 

The broad relationships of management, utilization, and physical 
plant, with all their ramifications, leave no desirable alternatives to 
the solution of specific problems other than judicious expansion. The 
decision has been reached, in principle, that the only realistic solution 
to the financial dilemma is at once the most imaginative and daring one. 
Although we are faced with the problem of expanding and therefore 
increasing, temporarily, the operating costs of an enterprise already 
operating at a loss, the conclusion to which we have come in the last 
six months is that we must plunge ahead in a major development program 
which will tax the resources of the Hospital and the community to the 
utmost. 




The One-Hundredth Anniversary Development Program 

The above proposal to solve the nagging financial problems of the 
C. H. M. C. through further growth and development is timely. In 1969, 
The Children's Hospital, incorporated on March 22, 1869, will celebrate 
its One-Hundredth Anniversary. The approach of a centennial celebra- 
tion places time on our side in the solution of our utilization and revenue 
problems, inasmuch as it provides a natural focus of inspiration, stimula- 
tion, and impetus. On the other hand, if we do not move ahead in 1963 
on a major first phase program that can be achieved by 1969, we may 
lose an opportunity that will not repeat itself for another hundred years, 
and, of equal importance, an opportunity which, if passed by, will 
jeopardize all other long-range plans. 

The first phase of the One-Hundredth Anniversary Development 
Program concerns itself with short-term needs. The second phase in- 
volves a longer range of planning and development. Each is described 
briefly in the sections to follow and illustrated in the accompanying 
architect's drawings. In actual fact, the two major phases that we con- 
template must be preceded by a staging phase, which we will first 
describe. 




ff-'-t&S 



Staging Phase 

The planned construction to be carried out as part of the One- 
Hundredth Anniversary Development Program is much like a gigantic 
chess game. A series of preliminary moves, on the surface unexciting 
but of pivotal importance, makes possible the next and final phases. 
Fortunately, these early moves can proceed at once, since they represent 
activities which are financially self-sustaining and do not require the 
use of endowment or building funds. 

Like many public institutions, The Children's Hospital Medical 
Center has been so warmly embraced by the automobile that there is 
virtually no space on which development can take place. A recent report 
on the city of Boston states that sixty per cent of Boston's land has been 
ceded to the automobile. We do not differ substantially from the city 
as a whole in that thirty-four per cent of our own land is devoted to 
parking. On this page an architect's drawing of a parking facility illus- 
trates the first new structure. This will consolidate all of the Hospital's 
parking facilities and make available other properties for new Hospital 
construction. 

Hospital housing presents specific problems which relate directly 
to the activities and concerns of those to be housed. For the benefit of 
the patient population, Residents and Interns are required to live on the 
Hospital grounds. Freely translated, this usually means acquisition by 
the Hospital of a nearby tenement house or placement of double bunks 
in an unused attic room. There are still a few doctors who, having gone 
through this themselves, endow living of this kind with a virtue of its 
own. We submit that this is a residual anachronism not properly a part 
of the young physician's educational process. Second, several hundred 
post-doctoral Fellows and visitors come to the Hospital each year. They 
arrive for varying lengths of time, speak a multitude of tongues, and 
are derived from all the racial and ethnic groups of the world. They 
immediately come into conflict with the hard realities of local real estate 
practices and the social vagaries of a community not yet ready to receive 
them in these numbers. A third group includes the graduate nurse 
desirous of spending a few years in a great medical center. She often 
has the edge of her enthusiasm blunted when it becomes apparent that 
she cannot live both economically and proximal to her place of employ- 



First step in entire program is con- 
struction of parking facility, con- 
venient to C. H. M. C, and permit- 
ting use of present parking area for 
construction of housing center. 



13 



Housing center for Residents, In- 
terns, Fellows, and graduate nurses 
will occupy former parking lot at 
Longwood and Brookline Avenues. 
A motel for patients and parents, 
as well as limited commercial ac- 
tivities, also are planned. 



ment. Last, the parents of our patients arriving from many cities and 
towns with concern for their child uppermost in their minds derive some 
degree of comfort from staying near the Hospital. 

We propose to combine all of these housing functions into a single 
housing complex, shown on this page. One tower will contain apartments 
of varying size for the graduate nurses and other professional employees. 
A second will house the resident and post-doctoral Fellows in quarters 
ranging from the single room for the unmarried to three- and four-room 
apartments for those whose families choose to live on the grounds. The 
lower structure pictured is the motel for parents and for some patients 
not yet well enough to return to their homes but not so sick as to require 
intensive hospital care. We feel the complex need not be spartan and 
have added, hopefully, the convenience of bank, post office, eating 
facility, and parking, plus space for a day-nursery. This latter will 
allow the Hospital to add to its rolls many young mothers whose specific 
talents we would put to use. Construction of this complex of buildings 
should begin in late 1963 or early 1964 and will complete the staging 
phase of the development program. 

First Major Development Phase 

Clinic, Clinical Research, and General Services Buildings. 

The last major building project at The Children's Hospital Medical 
Center was the modern, 300-bed, in-patient facility completed in 1956. 




14 



It was at first called Building B, but in 1961 was dedicated as the Farley 
Building, in honor of the late John Wells Farley, who had been President 
and Chairman of the Board of Trustees and the moving spirit both in 
the building campaign and in the concept of a constellation of institu- 
tions grouped in a medical center around The Children's Hospital. 

In the planning of the Farley Building, certain features were finally 
eliminated to keep construction within the limits of funds available. 
Thus, even as the new hospital building went into service, it was recog- 
nized that, while it should provide a general sufficiency of bed space 
for a long time to come, certain needs had not been met. These were 
substantially of four kinds: 

Modern, Centralized Out-Patient Clinics. The present Out-Patient 
Department on the ground and first floors on the Blackfan Street side 
of Building A at 300 Longwood Avenue is crowded and obsolete. As 
the medical care of children has shifted during the last decade more and 
more away from hospitalization and toward home care buttressed by clinic 
visits as needed, the out-patient service of the Hospital — particularly 
the emergency clinic — has sharply increased while the in-patient service 
has shown a much slower growth and some fluctuation. It is difficult, 
if not impossible, to provide attractive, efficient, and economical out- 
patient service in the present facilities. Little can be provided for the 
comfort and convenience of the patients and their parents. 

Clinical Research Laboratories. The Children's Hospital Medical 
Center has flourished as a teaching and research institution and undoubt- 
edly owes its greatness to the fact that its Staff is drawn from the 
Harvard Medical Faculty, that these men have been free to develop 
and pursue their ideas and interests as they relate to the child, that the 
Chiefs of Staff are pioneers in originating and applying pediatric knowl- 
edge and techniques, and that they have attracted hundreds of promising 
young men to train under them. Our research story was the theme of 
the 1961 Director's Report, by Mr. Williams, and I will nor attempt 
here to recapitulate it further. 

For some time, our Staff's research aspirations and the natural 
growth and development of the C. H. M. C. research program, totalling 
something in the neighborhood of $3,000,000 in annual grant support, 
have been hampered by lack of laboratory space. Opportunities for 
large Federal grants have hinged on the provision of adequate physical 
facilities, and in some cases have been lost through lack of the required 
space for research. We have the continuing obligation to provide modern, 
flexible, well-equipped laboratory facilities for those members of the 
Staff whose past contributions toward pediatric research have meant 
so much to the sick child. 

General Services. The administrative functions of The Children's 
Hospital Medical Center to a great extent have been tucked in here 
and there about the plant, insofar as department heads could obtain 
attention to their needs and compete for odd lots of space against our 
first order of business, which is professional services for patients. In the 
name of both efficiency and economy, the Administration recognizes 
a great need for consolidation coupled with expansion in this area, which 
is concerned with the nursing, social service, housekeeping, maintenance, 
accounting, record-keeping, and other administrative functions of a 
large hospital. It is logical that necessary development of such supporting 
facilities be combined with more dramatic and appealing needs in an 
over-all building program. 

New In-Patient Services. New Divisions and Departments within 
the Hospital structure are created in response to demonstrated com- 
munity needs. For a number of years the Hospital has been unable to 
continue its orderly development in these areas for lack of appropriate 
bed facilities. Some examples of our present thinking include: A psychi- 





Clinic and Clinical Research Build- 
ing complex, in the space between 
Building A and the Fatley Building, 
will provide much-needed facilities 
for out-patient clinics, clinical re- 
seatch labotatories, new in-patient 
services, etc. It is part of the First 
Major Development Phase. 



atric unit — there are almost no suitable in-patient facilities in the New 
England area where the acutely disturbed young child may receive proper 
psychiatric treatment in an atmosphere designed to meet the needs of 
a young child. We propose, therefore, to develop a psychiatric in- 
patient service to back up our constantly enlarging and excellent out- 
patient activities in psychiatry. The Department of Ophthalmology 
has for many years been without space for a clinic, adequate operating 
room, and a bed facility. The new building will include an entire floor 
devoted to modern operative and treatment facilities for the Depart- 
ments of both Otolaryngology and Ophthalmology. Exploratory dis- 
cussions with the Staff are now being carried out to determine the 
wisdom of establishing in-patient services in the clinical fields of re- 
habilitation, adolescent medicine, and dermatology. 

As the bricks-and-mortar materialization of the first major phase 
of our One-Hundredth Anniversary Development Program, we propose 
the construction of a modern building containing some 260,000 square 
feet of gross floor space to house out-patient clinics, clinical research 
laboratories, and general services plus certain additional in-patient units 
and diagnostic services. 

This new building would consist, in architectural terminology, of a 
three-story "pad" (sub-basement, basement, and ground floor) and two 
towers, as shown in the architect's drawing on this page. One tower, 
rising eight stories above the base building, would center on the patient 
facilities. The second tower, rising six stories, would be devoted to 
clinical research laboratories. 



16 



For some time, the site of a proposed Clinic and Clinical Research 
Building has remained in question, pending consideration of the "Har- 
vard Complex" proposal to integrate six teaching hospitals associated 
with Harvard Medical School on a new hospital site on or adjacent to 
the property of the Peter Bent Brigham Hospital. The question was to 
what extent The Children's Hospital might combine physical facilities 
with the other hospitals. In 1962, the Trustees endorsed the formation 
of a Harvard Hospital Center with The Children's Hospital Medical 
Center as a cooperating member, and declared that the C. H. M. C. would 
"continue to function separately but be closely related and increasingly 
affiliated with the new Hospital Center in future years." 

In view of this action and the earlier site recommendation of the 
Staff Executive Committee, together with further administrative con- 
sideration of the functions and logistics of a new building, a final deci- 
sion on site was reached. The new building will be placed in the un- 
occupied space between the Farley Building and Building A, requiring 
demolition only of two small, obsolete buildings. 

The building will cost $8,000,000 to $9,000,000, on the basis of 
preliminary estimates. 

The Trustees have authorized the Administration to proceed with 
final plans, with the expectation that groundbreaking will begin in the 
fall of 1963. 



Second Major Development Phase 

Completion of the first major development phase, the building pro- 
gram just described, would have 1968 as its target date. As shown in 
the architect's drawing on page 10, the second major development phase, 
beginning in 1969, would primarily involve the demolition of Building A 
and the old buildings on Longwood Avenue between Blackf an and Binney 
Streets and their replacement with a new arrangement of pad and towers 
extending from the edge of the Medical School's Longwood Quadrangle 
group of buildings to Binney Street (and, of course, architecturally 
continuous with the design of the Housing Center between Brookline 
Avenue and Binney Street). 

In this final phase, The Children's Hospital Medical Center would 
present a new and entirely modern face to its second century and the 
pediatric world of the future. In all probability, this second phase 
would cost an additional $10,000,000 to $12,000,000. 

Conclusion 

Our concentration on problems and how they may be solved, on 
weaknesses and how they may be strengthened, may seem to diminish 
or to overlook the many parts of the total organization in which Trustees, 
Staff, and Administration take great pride. In almost every respect the 
C. H. M. C. of today has exceeded the expectations of its founders. 
On the wards, the child from Roxbury shares both his doctors and his 
toys with his counterpart from Istanbul or Santiago. Each year the 
Hospital graduates scores of superbly trained physicians, nurses, and 
technicians, each to take his place in the Center's far-flung community. 
And from the crowded laboratories comes an endless series of small and 
large observations which promise hope for a better understanding of 
the afflictions of childhood. This diverse activity provides some sub- 
stantive evidence of continued youth in an otherwise venerable institution. 

Leonard W. Cronkhite, Jr., M.D. 
General Director 




17 



SOURCE OF CHILDREN'S HOSPITAL PATIENTS BY PLACE OF RESIDENCE 
For the Year Ending September 30, 1962 



MASSACHUSETTS: 



19,176 



Boston 



ELSEWHERE IN MASSACHUSETTS: 

\ : Barnstable County 





Berkshire County 
Bristol County 
Dukes County 
Essex County 
Franklin County 
Hampden County 



7,363 



11,813 

115 Hampshire County 121 

11.1 Middlesex County 4,910 

598 Nantucket County 18 

4 Norfolk County 2,118 

1,251 Plymouth County 667 

50 Suffolk County 656 

63 5 Worcester County 5 59 



ELSEWHERE 


[N THE UNITED STATES: 








r-wj 


Alabama 


6 


Montana 


3 


Alaska 


2 


Nebraska 


1 


- : -j~{ 


Arizona 


2 


Nevada 


1 


Arkansas 


2 


New Hampshire 


344 




California 


14 


New Jersey 


55 




Connecticut 


292 


New Mexico 


5 




Delaware 


2 


New York 


176 




District of Columbia 


3 


North Carolina 


8 




Florida 


42 


Ohio 


19 




Georgia 


9 


Oklahoma 


3 




Illinois 


14 


Pennsylvania 


25 




Indiana 


6 


Puerto Rico 


4 




Iowa 


1 


Rhode Island 


346 




Kansas 


10 


South Carolina 


9 




Kentucky 


5 


Tennessee 


2 




Louisiana 


2 


Texas 


3 




Maine 


289 


Vermont 


76 




Maryland 


7 


Virginia 


5 




Michigan 


7 


Washington 


5 




Minnesota 


4 


West Virginia 


6 




Missouri 


7 


Wisconsin 


8 



1,830 



ELSEWHERE IN THE WORLD: 

Africa 

Asia 

Canada 

Central America 



107 




1 

3 
36 

7 



Europe 
Mexico 

South America 
West Indies 

GRAND TOTAL 



9 
9 

40 

2 



21,113 



18 



CHANGES 

Dr. Adam J. Sortini, Director of Hearing and Speech Clinic for five 
years, left The Children's Hospital Medical Center for Children's Hospital 
in Halifax in July. He is succeeded by Dr. Allan C. Goodman. 

Mrs. Marie Smith, R.R.L., Director of the Medical Records Depart- 
ment since 1954, resigned on July 1, 1962, to go to the General Hospital 
in Greenwich, Connecticut. She is temporarily replaced by Miss Betsey 
Loveland. 

Mr. George Stilgoe became Plant Superintendent on July 23, 1962, 
replacing Mr. Arthur Stomberg, who is now Engineer for Planning and 
Construction. 

Miss Dorothy Rutherford, Executive Secretary of the Women's 
Committee for seven years, retired on August 17, 1962, and was replaced 
by Mrs. Olga Tingus. 

Mrs. Martha Stuart, who first came to The Children's Hospital 
Medical Center in 1925, retired on October 1, 1962, as Director of the 
Dietary Department, and was succeeded by Miss Maxine Gilson. 

Mr. John A. Lombardo became Administrative Assistant to the 
General Director on December 17. 

Mr. Greer Williams, Director of Development since 1960, left The 
Children's Hospital Medical Center on December 31, 1962 to join the 
Rockefeller Foundation as Consultant on Publications. 



19 



3n Jfflemortam 

Miss Theresa A. Hurley, Associate Director of the School of Nursing 
and President of the Nursing Alumnae Association, died on January 19, 
1962. She was a graduate of our School of Nursing and a member of our 
Staff since 193 5. 

Mr. Edward Murphy, a Member of The Children's Hospital Medical 
Center Corporation for many years whose family has graciously taken 
over his worthy efforts as a fund-raiser, died on February 4, 1962. 

Colonel Archibald William Smith, former Director of Resources, 
founder, then Executive Vice President and Trustee of Hospitals Laundry 
Association, Inc., and, upon his retirement, Chairman of the Board of the 
Laundry, died on February 27, 1962. 

Mr. Daniel J. McDevitt, a Corporation Member and generous sup- 
porter of Dr. Janeway's Kidney Fund, died on June 22, 1962. 

Dr. Meier G. Karp, Consultant in Orthopedic Surgery and member 
of the Orthopedic Surgery staff since 1937, died on September 13, 1962. 

Dr. L. Lahut Uzman, our first Neurologist-in-Chief and Bronson 
Crothers Professor of Neurology at Harvard Medical School, died on 
November 7, 1962. 

Dr. Conrad Wesselhoeft, Consultant in Infectious Diseases, Emeri- 
tus, died on December 1, 1962. 

Mr. Arthur G. Rotch, President of the Infants' Hospital for twenty- 
five years and one of our Trustees for sixteen years, died on December 9, 
1962. 

Dr. Maurice N. Kay, Associate in Medicine, died on December 22, 
1962. 



20 



WOMEN'S COMMITTEE OF THE CHILDREN'S 
HOSPITAL MEDICAL CENTER 

Executive Committee, 1962-1963 

OFFICERS: 

Mrs. David Wilder 

CHAIRMAN 

Mrs. Albert Pratt 

Mrs. Kenneth W. Warren 

VICE-CHAIRMEN 

Mrs. Richard C. Knight 

RECORDING SECRETARY 

Mrs. Randolph K. Byers 

CORRESPONDING SECRETARY 

Mrs. T. C. Haffenreffer, Jr. 

TREASURER 

MEMBERS: 

Mrs. Weston W. Adams 
Mrs. Charles F. Batchelder 
Mrs. Howard F. Gillette 
Mrs. Hans J. Kroto 
Mrs. Stephen Little 
Mrs. Oldfield B. Rapalyea 
Mrs. Philip C. Thibodeau 
Mrs. Jacob Wallace 
Mrs. Frederick R. Weed 

Mrs. Charles F. Hovey 
PAST CHAIRMAN 

Mrs. Robert B. Almy 

VOLUNTEER SERVICE 

Mrs. Robert H. Hopkins 
NOMINATING COMMITTEE 



REPORT OF 

WOMEN'S COMMITTEE, 1962 

For nearly 100 years The Children's 
Hospital Medical Center has been tak- 
ing care of sick children. This purpose 
— spelled out in the original charter — 
has not changed. Granted, our Hospi- 
tal started at another location, under 
the slightly different name of The 
Children's Hospital. The site has been 
moved. Buildings have been remod- 
eled, some torn down and replaced by 
new ones. Services from outlying dis- 
tricts have been consolidated. New 
drugs, new medical and surgical tech- 
niques have drastically changed patient 
tteatment. But we are still caring for 
sick children. It would seem that this 
past year has been one of constant re- 
appraisal and readjustment to the re- 
sponsibilities and needs of our partic- 
ular Hospital. We must continue to 
make these changes to give the best 
care. We must also do this with 
warmth and understanding for our 
young patients and their parents. 
Through suggestions offered by our 
new Director, Dr. Leonard W. Cronk- 
hite, Jr., the Women's Committee has 
re-evaluated many of our services to 
The Children's Hospital Medical Cen- 
ter. I think you will find that almost 
every committee has made some sort 
of change in its methods of operation. 

Perhaps the most tangible of our re- 
adjustments has been the reorganiza- 
tion of our financial structure — facili- 
tated by the patient guidance of Mr. 
Richard E. Held, the Controller. Fund- 
raising is not our primary purpose. But 
to give good service to our Hospital, 
we must have a sound and up-to-date 
financial foundation. The closing date 
for the annual accounting has been ad- 
vanced so that we may submit an ac- 
curate summary on a strictly cash basis. 
This naturally reduced our votable 
money for the year. Also, the closing 
of the Lunch Shop for alterations to 
the whole Hospital cafeteria area em- 
phatically cut profits. The Gift Shop 
suffered too. The mess and noise have 
not been conducive to relaxed shop- 
ping. Outside difficulties eliminated 
the South Shore Music Circus Benefit 
this summer. So a collective decrease 
of about $7,000 explains this dreary 
financial deficiency. Reorganization 
may often be temporarily expensive, 



21 



but it ultimately paves the way for 
greater profit. The Yankee Bookstall 
and the Thrift Shop have raised $3,000 
more — $1,500 each. Also, we are 
deeply grateful to the outside activities 
of the Cataumet Hospital Week 
( which actually lasted two months ) , 
the Daffodil Fair and the Dedham 
Skating Party for their generous con- 
tributions. 

The special events have been varied 
and interesting. On November 28, 
1961 at our Friends and Volunteers 
Meeting in the Jimmy Fund Building, 
Dr. J. Roswell Gallagher spoke about 
teen-age medical care. An absorbing 
movie in color supplemented his talk. 
Tea followed at Gardner House. On 
February 26, 1962, Dr. Charles A. 
Janeway was host to Dr. Andrea Prader 
from Zurich, Switzerland. We spon- 
sored this tea at the Medical Study 
Library. On March 13th, we welcomed 
the Executive Committee of the New 
England Peabody Home for Crippled 
Children at a tea at Gardner House. 
Subsequently, this group was invited 
to join our Committee. The Employees 
Service Award Ceremony on May 9th 
recognized the years of dedicated serv- 
ice of employees with special awards. 
The tea was provided by the collective 
efforts of Mrs. Martha Stuart of the 
cafeteria, Seilers, and the Women's 
Committee. 

Our annual Volunteer evening took 
place on May 15th. An increase of 
attendance necessitated the use of the 
Jimmy Fund Building. After the pres- 
entation of pins and certificates for 
hours and years of devoted volunteer 
service, Dr. William F. Bernhard 
talked about the new techniques in 
heart surgery and showed a fascinating 
film in color to illustrate his subject. 
On September 23rd, I had the honor 
once again of attending the Nurses' 
Graduation, a very inspiring occasion. 
Our Committee supplied the flowers. 

Within the Hospital we continued 
our services of weekly coffee hours for 
parents and monthly teas for nurses. 
We donated tickets, through a special 
fund, to Symphony, Pops, hockey, base- 
ball, and theatrical events to the House 
Staff and student nurses, who were 
most appreciative. Our annual Christ- 
mas Tea for doctors and nurses with 
Ruby Newman's festive music becomes 
an increasingly popular affair — with 



enthusiastic carol singing and dancing. 
The Staff Wives group, which is closely 
associated with our Committee, has 
been particularly active, providing 
many services and social occasions for 
incoming and outgoing Staff members. 

Outside the Hospital we attended 
with regularity the various hospital as- 
sociation meetings, ending the season 
with the American Hospital Associa- 
tion Convention in Chicago. 

At our monthly meetings, excellent 
speakers have kept us up-to-date on 
activities in various Hospital areas. 
Colored slides, movies, and tours sup- 
plemented the talks. Of special interest 
was the arrival of our new Director, 
Dr. Leonard W. Cronkhite, Jr., who 
outlined at our May meeting his im- 
mediate and future plans for the Hos- 
pital. 

REPORT OF THE 
SUBCOMMITTEES 

Christmas Window Painting — Chair- 
man, Mrs. George H. Sweetman. The 
suggestions of a young and apprecia- 
tive audience add the freshness to the 
annual efforts of this talented commit- 
tee which covers the windows with 
their charming Christmas decor. 
Decoration Committee — Chairman, 
Mrs. Kirke A. Neal. This busy group, 
working with the Hospital, redecorated 
the Psychiatric and Speech Clinics, Di- 
vision 35, and the Koplic Library. Dr. 
Green's teaching room received new 
chairs. The Volunteer area has been 
completely renovated with new paint 
and handsome new furniture. Mrs. 
Neal's expert advice will soon be dis- 
played in the attractive new Doctors' 
Dining Room, Lounge, and our ele- 
gantly remodelled Lunch Shop. 
Gift Shop — Chairman, Mrs. H. Ray- 
mond Wilkinson. The advanced clos- 
ing date of the annual accounts and the 
extensive alterations of the Lunch Shop 
affected the profits of the Gift Shop. 
However, we are grateful fot the gift 
of $2,000 and the enthusiastic support 
of the volunteers on this committee, 
who anticipate a much larger gift next 
year. 

Girl Scouts Committee — Chairman, 
Mrs. George A. Clapp. Sick and fre- 
quently lonely children are comforted 
by the cuddly animals, scrapbooks, and 
other toys made by the Girl Scouts. 
Old Christmas cards, empty spools, and 



salt boxes are welcomed materials for 
Mrs. Clapp's industrious group. 
Holiday Committee — Chairman, Mrs. 
Stephen Little. Nine holidays have 
been more festive for our sick children 
through the efforts of the Needham, 
Wellesley, and Dover Girl Scouts and 
the Boston and Weston Junior Red 
Cross, who provided tray favors (which 
they made) and hoodsies. 
Hospitality Coffees — Chairman, Mrs. 
Sidney H. Wirt. The weekly coffees 
on Wednesday afternoons have become 
an established custom. The attendance 
increases every year. From October 
through May, 624 parents from twenty- 
two States and seven foreign countries 
expressed the appreciation of the ef- 
forts of this busy committee, which is 
assisted by the ever-helpful Lunch 
Shop. 

Hospitality for Foreign Nurses — Chair- 
man, Mrs. Sherman R. Thayer. Again 
Mrs. Thayer has been welcoming the 
foreign nurses during the past year. 
She urges Women's Committee mem- 
bers to invite these nurses to their 
homes, particularly during the Thanks- 
giving and Christmas holidays. 
Knitting Committee — Chairman, Mrs. 
Francis A. Harding. Three loyal church 
groups and fifteen devoted individual 
knitters supplied the Hospital with 
152 articles — sweaters, bonnets, mit- 
tens, caps, socks, booties, afghans, as 
well as stuffed dolls and toys. 
Library Committee — Chairman, Mrs. 
Kenneth W. Warren. The conscien- 
tious workers of the Patients' Library 
and the House of the Good Samaritan 
Library have circulated 5,579 books. 
They have acquired 321 new books. 
A record number of State Reading Cer- 
tificates were awarded. Five-book cer- 
tificates went to thirty-three children. 
Twenty-book cettificates went to three 
children. Two cartons of books were 
dispatched to the Ranfurly Out-Islands 
Library in the Bahamas, thanks to the 
Yankee Bookstall. Of special note are 
several charming sketches, a gift of 
Mrs. Barbara Cooney Porter, who gave 
a "chalk talk" to delighted young pa- 
tients in the House of the Good Sa- 
maritan. 

Lunch Shop — Chairman, Mrs. Samuel 
S. Stevens. In spite of being closed for 
three months for complete renovation, 
the Lunch Shop donated the handsome 



22 



gift of $7,000. With a dashing new 
look it will re-open soon and continue 
to provide the Hospital with an essen- 
tial service. 

Membership Committee — Chairman, 
Mrs. George P. Buell. In the absence 
of Mrs. Buell, Mrs. Robert H. Hopkins 
reported a total membership of 576, 
of which 149 are Active and 199 are 
Associate, 89 Contributing and 139 
Sustaining. Hospital tours and infor- 
mal talks outlined the activities of the 
Women's Committee and the Volun- 
teer Service. 

Nurses' Teas — Chairman, Mrs. Edgar 
A. Bering, Jr. Informal monthly teas 
and the annual Christmas Party con- 
tinue to brighten the busy schedule of 
student and staff nurses, who greatly 
appreciate the efforts of this active 
committee. 

Photography — Chairman, Mrs. Albert 
A. Hittel. The smiling faces of sick 
children have given far-away parents 
and grandparents reassurance and 
pleasure. Thank-you letters in many 
languages are indicative of the value 
of this Polaroid service. 
Picture Committee ■ — ■ Chairman, Mrs. 
Charles F. Hovey. Many colorful prints 
and paintings, donated to the Women's 
Committee, were framed and hung in 
various clinic areas in the Hospital, 
adding a cheery note to waiting and 
examining rooms. 

Publicity — Chairman, Mrs. Robert M. 
P. Kennard. Throughout the year 
metropolitan and local newspapers 
reported and photographed our special 
activities, through the articulate efforts 
of Mrs. Kennard. 

Staff Wives Committee — Chairman, 
Mrs. Charles A. Janeway. Hospitality 
for House Staff and Fellows and their 
families is the major responsibility of 
this busy group. A supper dance, a tea, 
two picnics, housing assistance, and a 
furniture exchange were among its ac- 
tivities this past year. 
Surgical Dressings — Chairman, Mrs. 
Joel M. Barnes. Every Tuesday, winter 
and summer, this loyal committee pro- 
duced a yearly total of 99,353 dress- 
ings. The outside assistance of the 
circles of the First Baptist Church in 
Newton, a Scituate group, and the 
Temple Israel Sisterhood made 102,316 
dressings — giving the Hospital a grand 
total of 201,669. 



Thrift Shop — Chairman, Mrs. John M. 
Alden. The constant appeal for dona- 
tions and conscientious efforts of this 
committee produced the largest profit 
of $3,783.30 for our Hospital in ten 
years. A new and improved location 
at 656 Center Street, Jamaica Plain, 
should add to our Thrift Shop receipts 
— but only if supported by nice dona- 
tions from the Women's Committee. 
Volunteer Service Committee — Chair- 
man, Mrs. Robert B. Almy. This group 
functions as a liaison between volun- 
teer and professional services. Any 
joint activities or problems are dis- 
cussed and acted upon. 
Yankee Bookstall — Chairman, Mrs. 
Frederick R. Weed. We are proud of 
the Yankee Bookstall gift to The Chil- 
dren's Hospital Medical Center Build- 
ing Fund. A particularly successful 
sale contributed a gratifying sum of 
$6,214.30— nearly $1,500 more than 
last year. 

With deep regret we note the retire- 
ment of Miss Dorothy Rutherford, 
who has been our devoted Executive 
Secretary and a dear friend for seven 
years. At the October 1962 meeting, 
we expressed our sincere appreciation 
with the presentation of an engraved 
Paul Revere pitcher. Mrs. Olga Tingus 
is our new Secretary, with whom we 
enthusiastically anticipate the coming 
years. 

My heartfelt thanks to each Chair- 
man and Committee member who con- 
scientiously gave so much of herself 
and her valuable time. I am certain we 
will continue to serve our Children's 
Hospital Medical Center with the same 
purpose of dedication and understand- 
ing — but also with a new and adapt- 
able approach. 

Respectfully submitted, 

MRS. DAVID WILDER 

Chairman, Women's Committee 



23 



Women's Committee Financial Summary, 1962 



Cash on Deposit, September 30, 1961 
Transactions (Per Summary of Cash 
Reports for Fiscal Year Ending 
September 30, 1962): 
Add: Receipts 

Less : Disbursements 
Cash on Deposit, September 30, 1962 
Less: Cash Balance required for monthly expenses 
Available funds voted for 1962-1963 



$15,609.20 



33,920.44 

$49,529.64 

32,044.95 



$17,484.69 

2,000.00 

$15,484.69 



Distribution of Votable Funds, 1962-1963 

Yankee Bookstall proceeds to Building Fund 

Committee Operation Expense Items: 

Teas and Entertainment 

Staff Wives 

Holiday Committee 

Knitting Committee 

Library Committee 

Camera Fund 

Picture Fund 

Flower Fund 

Hospital Service Awards Ceremony 

Discretionary 

Contribution Items: 

Entertainment Tickets for Nurses 

Scholarship for Nurses 

Social Service 

Dr. Gardner 

Bowling Prize 

Department of Education and Recreation 

Total Voted: 



$ 6,214.30 



1,700.00 
1,000.00 
100.00 
100.00 
250.00 
100.00 
25.00 
450.00 
125.00 
250.00 



375.00 
500.00 
170.00 
100.00 
25.00 
i,000.00 



$ 4,100.00 



$ 5,170.00 
$15,484.30 



November 13, 1962 



24 



BOARD OF TRUSTEES 



Charles F. Adams 

Mrs. Robert B. Almy 

Kent Andrews 

Julian D. Anthony 

Neil R. Ayer 

Sherwin C. Badger 

Mrs. Nelson S. Bartlett 

Nelson S. Bartlett 

Mrs. Charles F. Batchelder, Jr. 

Matthew Berman 

Philip G. Bronstein 

John G. Brooks 

Stedman Buttrick 

Thomas D. Cabot 

John L. Cooper 

Frank W. Crocker 

Roger C. Damon 

Walter A. Dane 

J. Marshall Duane 

Joseph A. Erickson 

Hans H. Estin 

Donald Falvey 

Mrs. J. W. Farley 

Richard R. Flood 

F. Murray Forbes, Jr. 
Mrs. Edward L. Francis 
Mrs. Archer D. Friend 
Mrs. Dale Friend 

Dr. Claude M. Fuess 
Mrs. Robert G. Fuller 

G. Peabody Gardner 
George P. Gardner, Jr. 
Harrison Gardner 
John L. Gardner 
Francis H. Gleason 
Joseph Greenbaum 
Robert H. HaUoweU 
Lawrence H. Hansel 
Bartlett Harwood 
Miss Helen Hayes 
Paul F. Hellmuth 
Bruce D. Henderson 
Harvey P. Hood 

Mrs. Robert H. Hopkins 
Mrs. Charles F. Hovey 
Parkman D. Howe 
Weston Howland, Jr. 
Arnold W. Hunnewell 
Kenneth L. Isaacs 
Reginald Jenney 
Edward C. Johnson, II 
Milton Kahn 
John F. Kennedy 

President of the United States 
Richard C. Knight 



Frank L. Kozol 
Benjamin Kulp 
Henry A. Laughlin 
Arthur L. Lewis 
Robert J. Livermore 
Arthur H. Lockwood 
John W. Lowe 
William D. Manice, Jr. 
Austin B. Mason 
David A. Mittell 
Edward R. Mitton 
Mrs. John A. Moir 
William F. Morton 
George S. Mumford 
Mrs. Kirke A. Neal 
Harold L. Niles 
Robert C. Nordblom 
Adrian O'Keeffe 
Thomas A. Pappas 
Miss Amelia Peabody 
Mrs. James H. Perkins 
Edgar A. Perry 
Mrs. Roger A. Perry 
Mrs. Lewis I. Prouty 
Norman S. Rabb 
Miss Margaret A. Revere 
Walter J. Ripley, Jr. 
Edward Rose 
Thorvald S. Ross 
Serge Semenenko 
George Sherman 
Samuel Sidd 
William A. Silverman 
Samuel L. Slosberg 
Mrs. Charles E. Spencer, Jr. 
George A. Stockemer 
William N. Swift 
Mrs. Howard M. Turner 
James S. Turner 
Howland S. Warren 
Mrs. Alexander Wheeler 
Alexander Wheeler 
Mrs. Henry Wheeler, Jr. 
Henry K. White 
Alexander Whiteside 
Mrs. David Wilder 
Ben Ames Williams 
Mrs. Raymond Wing 
William W. Wolbach 



CORPORATION MEMBERS 



25 



Gordon Abbott 

L. Clayton Anderson 

Mrs. W. Benjamin Bacon 

Sherwood E. Bain 

Francis T. Baldwin 

Mrs. William DeFord Beal 

Richard A. Berenson 

David S. Bond 

George W. W. Brewster 

F. Gorham Brigham, Jr. 

Dr. Alexander Brin 

Francis H. Brooks 

Mrs. Paul Brooks 

William L. Brown 

Raymond J. Callahan 

Ephron Catlin, Jr. 

Mrs. Eugene H. Clapp, II 

Joseph A. Clapp, Jr. 

Miss Louise Coburn 

Hon. Richard Comerford 

Mrs. T. Jefferson Coolidge 

W. Edgar Crosby, Jr. 

Nelson J. Darling 

Charles Devens 

Willard Blake Dik 

Richard G. Dorr 

Albert P. Everts, Jr. 

Mrs. William S. Febiger 

Miss Adelaide Fitzgerald 

James F. Fitzgerald 

Mrs. Carlyle G. Flake 

John G Flint 

Alexander C. Forbes 

Mrs. F. Murray Forbes, Jr. 

A. Oram Fulton, Jr. 

Mrs. John L. Gardner 

John W. Goodrich 

Roland Gray, Jr. 

H. Frederick Hagemann, Jr. 

John M. Hall 

Mrs. Nathaniel Hamlen 

Mrs. Lawrence H. Hansel 

Francis A. Harding 

Francis W. Hatch, Jr. 

Mrs. Frederick D. Hawkins 

Christian A. Herter, Jr. 

Amor Hollingsworth, Jr. 

Mrs. Edward B. Hopkins 

Chandler Hovey 

Charles F. Hovey 

Henry S. Howe 

Mrs. Parkman D. Howe 

James F. Hnnnewell 

Charles Jackson 

Mrs. James Jackson, Jr. 

James Jackson, Jr. 

Marcien Jenckes 



Mrs. John C. Kiley, Jr. 

John C Kiley, Jr. 

Frederick M. Kimball 

John S. King 

John M. Kirk 

Harry J. Klotz 

C. Haven Ladd 

Mrs. Thomas H. Lanman 

Mrs. John E. Lawrence 

Henry M. Leen 

Paul Lerman 

George M. Lovejoy, Jr. 

Merritt B. Low, M.D. 

Stephen C. Luce, Jr. 

Daniel J. Lyne, Jr. 

C. Clark Macomber 

Robert T. Markson 

Mrs. Julian A. Marzynski 

Mrs. Robert C. Merriam 

Mrs. Harry S. Middendorf 

James J. Minot 

Harold A. Mock 

John A. Moir 

Burt F. Moody 

Hon. Francis X. Morrissey 

Major Nicholas P. Morrissey 

Frederick S. Moseley, III 

William G. Nickerson 

Charles B. Newhall 

Stanley O. Newman 

George Olmsted, Jr. 

J. Warren Olmsted 

Mrs. Henry W. Palmer, Jr. 

Henry W. Palmer, Jr. 

Willam A. Parker 

Robert G. Pease 

Louis R. Perini 

William Walrer Phelps, Jr. 

Mrs. Richard F. Piper 

Cary Potter 

Mrs. W. Elliott Pratt 

Harry A. Precourt 

Richard Preston 

Richard Prouty 

Francis B. Richardson 

Mrs. Homer B. Richardson 

Richard S. Robie 

Miss Emily Rockett 

Gerald Rosen 

Charles M. Rotch 

Edward G. Rudd 

George Shapiro 

Richard M. Smith, M.D. 

Sam Smith 

William B. Snow 

W. Brewster Southworth 

W. Frederick Spence 



John K. Spring 

D. B. Stanbro 

Geoffrey R. Stanwood 

Mrs. Bennett H. Stayman 

Edwin T. StefSan 

Charles H. Stockton 

Mrs. Philip Stockton 

Ernest F. Stockwell, Jr. 

Robert G. Stone 

Edward Sturgis, Jr. 

Frank J. Sulloway 

Humphrey H. Swift 

Mrs. John B. Tew 

Henry O. Tilton 

Mrs. Sherman R. Thayer 

Hon. George E. Thompson 

John S. Tufts 

Daniel Tyler, Jr. 

Linscotr Tyler 

Mrs. Jacob Wallace 

Mrs. Samuel D. Warren 

Mrs. Edwin S. Webster 

Edward A. Weeks, Jr. 

Richard S. West 

James V. Whalen 

Stephen Wheatland 

Alexander Wheeler, Jr. 

James G. Wheeler 

Loren C. White 

Howard S. Whiteside 

Mrs. Nehemiah H. Whitman 

John J. Wilson 

Mrs. Samuel H. Wolcott, Jr. 

Richard M. Wyman 



26 



THE CHILDREN'S HOSPITAL MEDICAL CENTER STAFF 



1962-1963 



DEPARTMENT OF MEDICINE 



PHYSICIAN-IN-CHIEF 

Charles A. Janeway, M.D. 

ASSOCIATE PHYSICIAN-IN-CHIEF 

Louis K. Diamond, M.D. 

SENIOR ASSOCIATES IN MEDICINE 

William Berenberg, M.D. 
Stewart H. Clifford, M.D. 
Thomas E. Cone, Jr., M.D. 
Charles D. Cook, M.D. 
John F. Crigler, Jr., M.D. 
R. Cannon Eley, M.D. 
Francis X. Fellers, M.D. 
J. Roswell Gallagher, M.D. 
Park S. Gerald, M.D. 
Robert J. Haggerty, M.D. 
Thomas C. Hall, M.D. 
Samuel L. Katz, M.D. 
Alexander S. Nadas, M.D. 
William I. Neikirk, M.D. 
David D. Rutstein, M.D. 
Harry Shwachman, M.D. 
Clement A. Smith, M.D. 
Leonid S. Snegireff, M.D. 

ASSOCIATES IN MEDICINE 

Donald M. Allen, M.D. (on leave) 

Olga E. Allers, M.D. 

DeWitt C. Baldwin, M.D. 

Robert B. Berg, M.D. 

John K. Brines, M.D. 

William D. Cochran, M.D. 

Allen C. Crocker, M.D. 

Leonard W. Cronkhite, Jr., M.D. 

William R. Dorsey, M.D. 

James E. Drorbaugh, M.D. 

Edward C. Dyer, M.D. 

Audrey E. Evans, L.R.C.P., S.E. 

(on leave) 
Albert A. Frank, M.D. 
Helen H. Glaser, M.D. 
Sidney Green, M.D. 
Robert D. Griesemer, M.D. 
Jerome A. Grunt, M.D. 
Sprague W. Hazard, M.D. 
John P. Hubbell, Jr., M.D. 
George Kahn, M.D. 
Alexander S. MacDonald, M.D. 
Anna Mitus, L.R.C.P. 
Robert T. Moulton, M.D. 
Otto S.Nau, M.D. 
William Pfeffer, M.D. 
Gertrud C. Reyersbach, M.D. 
Fred S. Rosen, M.D. 
James R. Sayre, M.D. (on leave) 
E. Manning Sears, M.D. 
William J. Turtle, M.D. 
John W. G. Tuthill, M.D. 
William D. Winter, M.D. 



ASSISTANTS IN MEDICINE 

Joel J. Alpert, M.D. 
Euan T. Blanch, M.D. 
T. Berry Brazelton, M. D. 
Albert Cohen, M.D. 
Kelley K. Davis, M.D. 
Karel deHaas, M.D. 
William A. Dickson, M.D. 
Thomas F. Dolan, Jr., M.D. 
Stephen M. Frawley, M.D. 
Harold J. Freedman, M.D. 
Ellen S. Kang, M.D. 
William F. Ketchum, M.D. 
Charles S. Keuper, M.D. 
Sherwin V. Kevy, M.D. 
Kon Taik Khaw, M.D. 
Howard S. King, M.D. 
Leon E. Kruger, M.D. 
Jane C. MacLeod, M.D. 
D. Hugh MacNamee, M.D. 
Lillian A. F. McMackin, M.D. 
Myron Morris, M.D. 
Donald M. Muirhead, Jr., M.D. 
Alice Nauen, M.D. 
Alexander L. O'Hanley, M.D. 
Robert J. Orme, M.D. 
Joseph Osborne, M.D. 
Julian Pearlman, M.D. 
Thomas C. Peebles, M.D. 
Howard J. Potter, M.D. 
Henry M. Putnam, M.D. 
Daniel R. Rectanus, M.D. 
John S. Robey, M.D. 
Oliver F. Roddey, Jr., M.D. 
Murray K. Rosenthal, M.D. 
Herbert L. Ruben, M.D. 
Robert T. Sceery, M.D. 
Gerald B. Shattuck, M.D. 
Samuel N. Sherry, M.D. 
George Siegel, M.D. 
Leslie Silverstone, M.D. 
George H. Taft, M.D. 
John S. Taub, M.D. 
Evelyn D. Waitskin, M.D. 
Richard H. Watson, M.D. 
Harold J. Wheeler, M.D. 
Martin K. White, M.D. 

RESEARCH ASSOCIATES IN MEDICINE 

John A. Cavins, M.D. 
Patricia Charache, M.D. 
Norman I. Gold, Ph.D. 
Miriam D. Manning, M.D. 
Donald H. McGlory, M.D. 
Ezio Merler, M.D. 

VISITING RESEARCH ASSOCIATE 

IN MEDICINE 

Werner Jacobson, M.D. 



General Medical Divisions 

Adolescent Unit 

CHIEF 

J. Roswell Gallagher, M.D. 

SENIOR ASSOCIATE IN MEDICINE 

Thomas E. Cone, Jr., M.D. 

ASSOCIATE IN MEDICINE 

Robert P. Masland, Jr., M.D. 

ASSISTANTS IN MEDICINE 
Richard O Elliott, M.D. 
Charles S. Gleason, M.D. 
Andrew D. Guthrie, M.D. 
John A. Spargo, M.D. 
Harry B. Stults, Jr., M.D. 

RESEARCH ASSOCIATE 

Carl C. Seltzer, Ph.D. 

CONSULTING PHYSICIANS 

C. Cabell Bailey, M.D. 
Watren R. Guild, M.D. 
William R. Hill, M.D. 
Simeon Locke, M.D. 
W. Warren Point, M.D. 
Herbert A. Selenkow, M.D. 

CONSULTING OPHTHALMOLOGIST 

Albert E. Sloane, M.D. 

CONSULTING GYNECOLOGIST 

Somers H. Sturgis, M.D. 

Child Health Division 

CHIEF 

Robert J. Haggerty, M.D. 

ASSOCIATES IN MEDICINE 

Helen H. Glaser, M.D. 
M. Grace Hussey, M.D. 
Dorothea May Moore, M.D. 
Ralph A. Ross, M.D. 
Abraham S. Small, M.D. 
Lendon Snedeker, M.D. 
Leon Sternfeld, M.D. 

ASSISTANTS IN MEDICINE 

Joel J. Alpert, M.D. 
Use E. J. Gorbach, M.D. 
Charlotte G. Neumann, M.D. 
Eva J. Salber, M.D. 
Arthur J. Salisbury, M.D. 
Samuel N. Sherry, M.D. 
Isabelle Valadian, M.D. 

CONSULTING PHYSICIANS 

Robert K. Funkhouser, M.D. 
Frank A. Howard, M.D. 

CONSULTING OBSTETRICIAN 

John J. Driscoll, M.D. 



27 



DEPARTMENT OF SURGERY 



Infants' and Children's 
Medical Division 

CHIEF 

William Berenberg, M.D. 



Medical Gut-Patient Department 

CHIEF 

Charles D. Cook, M.D. 



Neivborn Division 

CHIEF 

Samuel L. Katz, M.D. 



Special Medical Divisions 
Allergy Division 

ALLERGIST 

Harry L. Mueller, M.D. 

ASSOCIATES IN ALLERGY 

Irving W. Bailit, M.D. 
Otto S. Nau, M.D. 

ASSISTANTS IN ALLERGY 

Theodore Bennett, M.D. 
Frederick Blumenthal, M.D. 
Elizabeth A. Gregory, M.D. 
Lawrence S. Morse, M.D. 
Harold J. Wheeler, M.D. 

Cardiology Division 

CARDIOLOGIST 

Alexander S. Nadas, M.D. 

SENIOR ASSOCIATE IN CARDIOLOGY 

Anna J. Hauck, M.D. 

ASSOCIATES IN CARDIOLOGY 

Paul G. Hugenholtz, M.D. 
R. Grier Monroe, M.D. 

ASSISTANTS IN CARDIOLOGY 

Walter H. Abelmann, M.D. 
Albert Cohen, M.D. 
Joseph G. Cutler, M.D. 
Walter T. Goodale, M.D. 
A. A. Sasahara, M.D. 
Jacob Wallace, M.D. 
Richard Wolff, M.D. 

Good Samaritan Division 
CHIEF 

Charles A. Janeway, M.D. 



SENIOR ASSOCIATES IN MEDICINE 

Edward F. Bland, M.D. 
Gabor Czoniczer, M.D. 
Allan L. Friedlich, M.D. 
Sprague W. Hazard, M.D. 
Benedict F. Massell, M.D. 
Sylvester McGinn, M.D. 
Alexander S. Nadas. M.D. 
Marian W. Ropes, M.D. 
David D. Rutstein, M.D. 
George P. Sturgis, M.D. 
Raymond Walther, M.D. 
Edwin O. Wheeler, M.D. 

Rheumatic Fever Research Unit at the 
House of the Good Samaritan 

DIRECTOR 

Benedict F. Massell, M.D. 

RESEARCH ASSOCIATES 

Gabor Czoniczer, M.D. 
J. Gabriel Michael, Ph.D. 

RESEARCH ASSISTANT 

Thomas Michael, A.M., M.S. 



Hematology Division 

HEMATOLOGIST 

Louis K. Diamond, M.D. 

ASSOCIATE IN HEMATOLOGY 

Park S. Gerald, M.D. 

ASSISTANTS IN HEMATOLOGY 

Sherwin V. Kevy, M.D. 
Herbert S. Strauss, M.D. 

RESEARCH ASSOCIATE IN MEDICINE 

Mary Louise Efron, M.D. 



SURGEON-IN-CHIEF 

Robert E. Gross, M.D. 

SENIOR ASSOCIATES IN SURGERY 

Luther A. Longino, M.D. 
Donald W. MacCollum, M.D. 

ASSOCIATES IN SURGERY 

William F. Bernhard, M.D. 
Thomas W. Botsford, M.D. 
John W. Chamberlain, M.D. 
Chilton Crane, M.D. 
Samuel R. Schuster, M.D. 
George W. B. Starkey, Jr., M.D. 

ASSISTANTS IN SURGERY 

Arnold H. Colodny, M.D. 
Judson G. Randolph, M.D. 



DEPARTMENT OF 
OTOLARYNGOLOGY 

OTOLARYNGOLOGIST-IN-CHIEF 

Carlyle G. Flake, M.D. 

SENIOR ASSOCIATE IN 
OTOLARYNGOLOGY 

Charles F. Ferguson, M.D. 

ASSOCIATES IN OTOLARYNGOLOGY 

Sydney Shore, M.D. 
John C. Trakas, M.D. 

Hearing and Speech Clinic 

DIRECTOR 

Allan C. Goodman, Ph.D. 

SPEECH PATHOLOGIST 

Walter L. Cullinan, Ph.D. 



DEPARTMENT OF 
OPHTHALMOLOGY 

OPHTHALMOLOGIST-IN-CHIEF 

Trygve Gundersen, M.D. 

SENIOR ASSOCIATE 
IN OPHTHALMOLOGY 

Sumner D. Liebman, M.D. 

ASSOCIATE IN OPHTHALMOLOGY 

S. Forrest Martin, M.D. 

ASSISTANTS IN OPHTHALMOLOGY 
Arthur F. Calnan, M.D. 
Alfred W. Scott, M.D. 



28 



DEPARTMENT OF PSYCHIATRY 



PSYCHIATRIST-IN-CHIEF 

George E. Gardner, Ph.D., 



M.D. 



SENIOR ASSOCIATES IN PSYCHIATRY 
Children's Hospital 

Tully Benaron, M.D. 
Lydia Dawes, M.D. 
Henry Wermer, M.D. 

Judge Baker 

Elizabeth S. Makkay, M.D. 

ASSOCIATES IN PSYCHIATRY 
Children's Hospital 

Chester C. d'Autremont, M.D. 
Abraham Fineman, M.D. 
Herbert I. Harris, M.D. 

Judge Baker 

John C. Coolidge, M.D. 
Dorothy Macnaughton, M.D. 
Donald Russell, M.D. 
Peter H. Wolff, M.D. 

ASSISTANTS IN PSYCHIATRY 
Children's Hospital 

Graham B. Blaine, Jr., M.D. 
John R. Blitzer, M.D. 
Dexter Bullard, M.D. 
William Crowell, M.D. 
Richard Galdston, M.D. 
Marvin B. Krims, M.D. 
Robert Mehlman, M.D. 
Alan Prager, M.D. 
Nancy Rollins, M.D. 
William E. Stone, M.D. 
Harold Wolman, M.D. 

Judge Baker 

Anna C. Brown, M.D. 

George Cloutier, M.D. 

Alice Fleming, M.D. 

Stuart Q. Flerlage, Jr., M.D. 

Thomas Frank, M.D. 

Joseph J. Mullen, M.D. 

John Weil, M.D. 

Lee M. Wilier, M.D. 

Edward Woicik, M.D. 

Joan J. Zilbach, M.D. 

PSYCHOLOGISTS 
Children's Hospital 

Joseph P. Lord, Ph.D., Chief 
Amy Blackwell, Ph.D. 
Haskel Cohen, Ph.D. 
Daniel Daum, MA. 
Miriam Fiedler, Ph.D. 
Stuart Gerber, MA. 
Margaret Ingram, MA. 



Elaine Loomis, MA. 
Patricia Jo Nair, Ph.D. 
Geraldine Rickard, Ed.D. 
Ann Salomon, Ph.D. 
Celia Schulhoff, MA. 
Annette Silbert, Ph.D. 
Albert Trieschman, Ph.D. 
Charles Woodbury, Ph.D. 

Judge Baker 

Bessie Sperry, Ph.D., Chief 

Pauline Harm, Ph.D., Research Director 

Richard Brodie, Ph.D. 

Irving Hurwitz, Ph.D. 

Hyman Kempler, Ph.D. 

Arne Korstvedt, Ph.D. 

Clementina Kuhlman, Ph.D. 

Norman Prentice, Ph.D. 

David Ricks, Ph.D. 

Max Schleiffer, Ph.D. 

Milton Shore, Ph.D. 

Robert Templeton, Ed.D. 

Ellen Tessman, Ph.D. 

Nicolas Verven, Ph.D. 

Robert Young, Ed.D. 

RESEARCH ASSOCIATES 

Sydney Croog, Ph.D. 
Eric Lenneberg, Ph.D. 
Barbara K. Sutherland, Ph.D. 
James Teele, Ph.D. 



DEPARTMENT OF ANESTHESIA 

ANESTHESIOLOGIST-IN-CHIEF 

Robert M. Smith, M.D. 

ASSOCIATES IN ANESTHESIOLOGY 

John G. Adams, Jr., M.D. 
Dean Crocker, M.D. 
John B. Stetson, M.D. 

ASSISTANT IN 
ANESTHESIOLOGY 

Carol H. Johnson, D.D.S. 



DEPARTMENT 
OF DENTISTRY 

DENTIST-IN-CHIEF 

Paul K. Losch, D.D.S. 

SENIOR ASSOCIATES IN 
ORTHODONTICS 

Melvin I. Cohen, D.M.D. 
Lennard T. Swanson, D.M.D. 

ASSOCIATE IN ORAL SURGERY 

Walter C. Guralnick, D.M.D. 



ASSOCIATE IN ORTHODONTICS 

Edward I. Silver, D.M.D. 

ASSISTANTS IN PEDODONTIA 

Harry K. Bailey, D.M.D. 
Norman T. Budde, D.M.D. 
Owen W. Kite, D.M.D. 
Robert F. Watton, D.M.D. 

ASSISTANTS IN ORTHODONTICS 
Henry C. Beebe, D.D.S. 
Emory Farrington, D.M.D. 
Abijah Pierce, D.M.D. 



DEPARTMENT OF 
ORTHOPEDIC SURGERY 



ORTHOPEDIC SURGEON-IN-CHIEF 

William T. Green, M.D. 

SENIOR ASSOCIATES IN ORTHOPEDIC 

SURGERY 

Henry H. Banks, M.D. 

Jonathan Cohen, M.D. 

Paul W. Hugenberger, M.D. 

Arthur W. Trott, M.D. 

ASSOCIATES IN ORTHOPEDIC SURGERY 

Frank D. Bates, M.D. 
Paul P. Griffin, M.D. 
Mihran O. Tachdjian, M.D. 

ASSISTANT IN ORTHOPEDIC SURGERY 

Richard G. Eaton, M.D. 

RESEARCH ASSOCIATE 

Margaret Anderson, M.S. 

RESEARCH ASSISTANT 

Mary E. Arnold, MA. 



DEPARTMENT OF 
NEUROSURGERY 



NEUROSURGEON-IN-CHIEF 

Franc D. Ingraham, M.D. (on leave) 
Donald D. Matson, M.D. (Acting) 

SENIOR ASSOCIATE IN 
NEUROSURGERY 

John Shillito, Jr., M.D. 

ASSOCIATES IN NEUROSURGERY 

Edgar A. Bering, Jr., M.D. 
Joseph H. Galicich, Jr., M.D. 



DIVISION OF LABORATORIES AND RESEARCH 



29 



CHAIRMAN 

Sidney Farber, M.D. 



DEPARTMENT OF PATHOLOGY 

PATHOLOGIST-IN-CHIEF 

Sidney Farber, M.D. 

PATHOLOGIST 

Gordon F. Vawter, M.D. 

ORTHOPEDIC PATHOLOGIST 

Jonathan Cohen, M.D. 

NEUROPATHOLOGIST 

Floyd H. Gilles, M.D. 

ASSISTANT PATHOLOGISTS 

Jules Edlow, M.D. 
Hubert Jockin, M.D. 

SENIOR ASSOCIATES IN PATHOLOGY 

Samuel S. Epstein, M.D. 
Agnes B. Russfield, M.D. 
Betty Ben Geren Uzman 

RESEARCH ASSOCIATES 

Richard A. Adams, Ph.D. 
Rogelio Alarcon, M.D. 
Giuliana Cardinali, D.Sc. 
Giuseppe Cardinali, M.D. 
Donald L. D. Caspar, Ph.D. 
Elizabeth F. Claflin, Ph.D. 
Carolyn Cohen, Ph.D. 
J. LeRoy Conel, Ph.D. 
Allen C. Crocker, M.D. 
Margarida Dederick, M.D. 
George E. Foley, Sc.D. 
Shou Cheng J. Fu, Ph.D. 
Thomas C. Hall, M.D. 
Alfred H. Handler, Ph.D. 
Mervyn Israel, Ph.D. 
Robert Langridge, Ph.D. 
Susan Lowey, Ph.D. 
Charlotte L. Maddock, M.D. 
Sergio Magalini, M.D. 
Saul Malkiel, Ph.D., M.D. 
Arlene L. Mazzone, Ph.D. 
Robert E. McCarthy, Ph.D. 
Edward J. Modesr, Ph.D. 
Hans B. Nevinny, M.D. 
B. DeWayne Roberts, Ph.D. 
Andre Rosowsky, Ph.D. 
Sisir K. Sengupta, Ph.D. 
Elizabeth R. Simons, Ph.D. 
Michael Spencer, Ph.D. 
George Yerganian, Ph.D. 

RESEARCH ASSISTANTS 

Virginia Binns, Sc.B., M.T. 
Barbara Brown, B.A. 



Gwladys W. Caspar, B.S. 
Sah Sook Cho, M.S. 
Sunil Dasgupta, Ph.D. 
Jacob Goldstein, Ph.D. 
Ellen R. Hanley, B.S.A. 
John Howard 
Joseph Kucera, B.A. 
Ruth Langridge, A.M.T. 
Mary D. Mello, B.S.A. 
Koichi Morita, B.Ph. 
Heljo K. Protopapa, B.A. 
Albert Roy, MA. 
Emanuel Shecter, Ph.D. 
Ho Ti. M.S. 
Dorothy H. Trites, B.S. 



LABORATORIES OF 
CLINICAL PATHOLOGY 

CHIEF 

Harry Shwachman, M.D. 

BACTERIOLOGIST 

George E. Foley, Sc.D. 

RESEARCH ASSOCIATES 

John T. Clarke, Ph.D 
Morris N. Green, Ph.D. 

RESEARCH ASSISTANT 

Abbas Mahmoodian, Ph.D. 



RESEARCH DIVISION 

OF INFECTIOUS DISEASES 

CHIEF 

John F. Enders, Ph.D. 

RESEARCH ASSOCIATES 

Ion Gresser, M.D. 
Samuel L. Katz, M.D. 



TUMOR THERAPY DIVISION 

SENIOR ASSOCIATES IN MEDICINE 

William Berenberg, M.D. 
Thomas C. Hall, M.D. 
William I. Neikirk, M.D. 
Harry Shwachman, M.D. 
Leonid Snegireff, M.D. 

ASSOCIATES IN MEDICINE 

Allen C. Crocker, M.D. 

Audrey E. Evans, M.D. (on leave) 

Clementina Geiser, M.D. 

Anna Mitus, L.R.C.P. 

E. Manning Sears, M.D. 

Leslie Silverstone, M.D. 



RADIOTHERAPIST 

Giulio J. DAngio, M.D. 

RESEARCH ASSOCIATES IN MEDICINE 

John A. Cavins, M.D. 
Miriam D. Manning, M.D. 
Larry Nathanson, M.D. 
Hans B. Nevinny, M.D. 



DEPARTMENT OF RADIOLOGY 

RADIOLOGIST-IN-CHIEF 

Edward B. D. Neuhauser, M.D. 

RADIOLOGIST 

Martin H. Wittenborg, M.D. 

RADIOTHERAPIST 

Giulio J. DAngio, M.D. 

SENIOR ASSOCIATE 
IN RADIOLOGY 

G. B. Clifton Harris, M.D. 

ASSISTANTS IN RADIOLOGY 

N. Thorne Griscom, M.D. 
Melvin TefTt, M.D. ( Radiotherapy ) 
(on leave) 



DEPARTMENT OF NEUROLOGY 

NEUROLOGIST-IN-CHIEF 

Charles Barlow, M.D. 

ASSOCIATES IN NEUROLOGY 

Cesare T. Lombroso, M.D. 
Donald H. Osterberg, M.D. 
H. Richard Tyler, M.D. 

CONSULTING NEUROLOGIST 

Randolph K. Byers, M.D. 



30 



CONSULTANTS 



EMERITI 



MEDICINE 

Benjamin Alexander, M.D. 

COMPARATIVE PATHOLOGY 

Donald L. Augustine, M.D. 

MEDICINE 

Theodore L. Badger, M.D 

ORTHOPEDIC SURGERY 

Joseph S. Barr, M.D. 
PATHOLOGY 
Elkan Blout, Ph.D. 

UROLOGY 

Hathorn P. Brown, M.D. 

OPHTHALMOLOGY 

Paul A. Chandler, M.D. 

OPHTHALMOLOGY 

David G. Cogan, M.D. 

PATHOLOGY 

Gustave J. Dammin, M.D. 

MICROBIOLOGY 

Bernard D. Davis, M.D. 

PSYCHIATRY 

Felix Deutsch, M.D. 

MEDICINE 

Lewis Dexter, M.D. 

PATHOLOGY 

Isaac Djerassi, M.D. 
OPHTHALMOLOGY 

Edwin B. Dunphy, M.D. 

ORTHOPEDIC SURGERY 

William A. Elliston, M.D. 

MEDICINE 

Kendall Emerson, M.D. 

MEDICINE 

Dana L. Farnsworth, M.D. 

ANATOMY 

Don W. Fawcett, M.D. 

ENVIRONMENTAL HEALTH 

Benjamin G. Ferris, M.D. 

ANESTHESIOLOGY 

Jacob Fine, M.D. 

MEDICINE 

Sydney S. Gellis, M.D. 

UROLOGY 

J. Hartwell Harrison, M.D. 

PATHOLOGY 

Arthur Hertig, M.D. 

PATHOLOGY 

Oscar Hirsch, M.D. 

ANTHROPOLOGY 

William W. Howells, Ph.D. 

SURGERY 

Henry W. Hudson, Jr., M.D. 

INFECTIOUS DISEASES 

Edward Kass, M.D. 

BIOCHEMISTRY 

Eugene P. Kennedy, Ph.D. 



INFECTIOUS DISEASES 

Sidney Kibrick, M.D. 

PATHOLOGY 

Edmund Klein, M.D. 

PHARMACOLOGY 

Otto Krayer, M.D. 

PHYSIOLOGY 

Eugene M. Landis, M.D. 

MEDICINE 

Samuel A. Levine, M.D. 

MEDICINE 

Arthur J. Linenthal, M.D. 

RADIOLOGY 

Joseph Marks, M.D. 

NUTRITION 

Jean Mayer, Ph.D., D.Sc. 

PATHOLOGY 

William Meissner, M.D. 

SURGERY 

Francis D. Moore, M.D. 

PLASTIC SURGERY 

Joseph E. Murray, M.D. 

OBSTETRICS 

Duncan Reid, M.D. 
CHILD HEALTH 

William M. Schmidt, M.D. 

OTOLARYNGOLOGY 

Harold F. Schuknecht, M.D. 

RADIOLOGY 

Magnus Smedal, M.D. 

NUCLEAR MEDICINE 

Arthur Solomon, M.D. 

GYNECOLOGY 

Somers H. Sturgis, M.D. 

PSYCHOLOGY 

Edith M. Taylor, M.D. 

NEOPLASTIC DISEASES 

Grantley W. Taylor, M.D. 

MEDICINE 

George W. Thorn, M.D. 

SURGERY 

Carl W. Walter, M.D. 

PATHOLOGY 

Shields Warren, M.D. 

PHYSICS IN RADIOLOGY 

Edward W. Webster, Ph.D. 

INFECTIOUS DISEASES 

Louis Weinstein, M.D. 

STOMATOLOGY 

David Weisberger, M.D. 

PARASITIC AND VIRAL DISEASES 

Thomas H. Weller, M.D. 

PHYSIOLOGY 

James L. Whittenberger, M.D. 

NEUROPATHOLOGY 

Paul Yakovlev, M.D. 

MEDICINE 

Paul M. Zoll, M.D. 



ORTHOPEDIC SURGEON, EMERITUS 

Albert H. Brewster, M.D. 

CONSULTANT IN MEDICINE, EMERITUS 

C. Sidney Burwell, M.D. 

CONSULTANT IN MEDICINE, EMERITUS 

Allan M. Butler, M.D. 

CONSULTANT IN DERMATOLOGY, 

EMERITUS 

Austin W. Cheever, M.D. 

CONSULTANT IN NEUROLOGY, 

EMERITUS 

Stanley Cobb, M.D. 

SENIOR ASSOCIATE IN MEDICINE, 
EMERITUS 

John A. V. Davies, M.D. 

CONSULTANT IN CHILD HEALTH, 
EMERITUS 

Martha M. Eliot, M.D. 

SENIOR ASSOCIATE IN MEDICINE 
EMERITUS 

Henry Gallup, M.D. 

PHYSICIAN, EMERITUS AND 
ALLERGIST, EMERITUS 

Lewis W. Hill, M.D. 

PHYSICIAN, EMERITUS 

Eliot Hubbard, Jr., M.D. 
SURGEON-IN-CHIEF, EMERITUS 

William E. Ladd, M.D. 

CONSULTANT IN SURGERY, EMERITUS 

Charles G. Mixter, M.D. 

ORTHOPEDIC SURGEON, EMERITUS 

Robert H. Morris, M.D. 

CONSULTANT IN SURGERY, EMERITUS 

Francis C. Newton, M.D. 
ORTHOPEDIC SURGEON, EMERITUS 

James W. Sever, M.D. 

ASSOCIATE IN MEDICINE, EMERITUS 

David W. Sherwood 

PHYSICIAN-IN-CHIEF, EMERITUS 

Richard M. Smith, M.D. 

CONSULTANT IN CHILD HEALTH, 

EMERITUS 

Harold C. Stuart, M.D. 

PHYSICIAN, EMERITUS 

Edwin T. Wyman, M.D. 



31 



THE CHILDREN'S HOSPITAL MEDICAL CENTER 
FORM OF BEQUEST 

I give, devise, and bequeath to The Children's Hospital 
Medical Center, in the City of Boston, and Commonwealth 
of Massachusetts, the sum of 



Architect's model of C. H. M. C. as it is today graphically shows how reassignment of land use will enable 
building program to be accomplished. 




First phase of building program — ■ construction of garage, housing center, and clinic and clinical research 
complex — is illustrated by architect's model. Photo on back cover shows model of how C. H. M. C. will 
appear when entire building program is completed. 




33 
REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Report of Physician-in-Chief 3 5 

Report of Chief, Adolescent Unit 54 

Report of President of the House of the Good Samaritan 56 

Report of Chief of the House of the Good Samaritan Division 57 

Report of Director of 

Rheumatic Fever Research Unit at the House of the Good Samaritan 59 

Report of Neurologist-in-Chief 62 

Report of Neurosurgeon-in-Chief 64 

Report of Orthopedic Surgeon-in-Chief 69 

Report of Chairman, Division of Laboratories and Research 75 

Report of Psychiatrist-in-Chief 89 

Report of Radiologist-in-Chief 99 

Report of Surgeon-in-Chief 102 

Report of Anesthesiologist-in-Chief 108 

Report of Dentist-in-Chief 111 

Report of Ophthalmologist-in-Chief 113 

Report of Otolaryngologist-in-Chief 114 

Report of Chairman, Staff Planning Committee 116 



35 



PHYSICIAN-IN-CHIEF 



REPORT OF 
PHYSICIAN-IN-CHIEF 

This report provides a special oppor- 
tunity for stock-taking, since the ap- 
pointment of Dr. Cronkhite as General 
Director has given this Institution the 
administrative strength its growth re- 
quires. Consequently, we are on the 
threshold of a new era in which it will 
be possible to implement the plans that 
the Staff has been making for a num- 
ber of years. Moreover, since this 
report marks the half-way mark in my 
own projected term as Physician-in- 
Chief, it is a good time to look back 
in order to try to plan wisely for the 
future. ^jH 

Medical Progress in the 
Past Fifteen Years 

During the past two decades, there 
has been extraordinary medical prog- 
ress, due to the application of the 
rapidly expanding knowledge in the 
basic medical sciences — particularly 
biochemistry and pharmacology — to 
the solution of clinical problems. This 
has placed powerful drugs in the hands 
of the physician, so that he no longer 
is only a sympathetic diagnostician but, 
like his colleague in surgery, has ac- 
quired the power to cure as well as to 
harm many of his patients. Following 
introduction of the sulfonamides in 
1936, and the development of penicil- 
lin in the early 1940's, a steady stream 
of antimicrobial drugs has poured out 
of the pharmaceutical laboratories, thus 
totally changing the outlook in those 
bacterial infections which took so 
many lives in the past. Meningitis, 
osteomyelitis, pneumonia, tuberculosis, 
scarlet fever, ear and mastoid infec- 
tions, and rheumatic fever no longer 
present the threat to life and health 
which they used to, provided they are 
recognized promptly and adequately 
treated. New drugs to control the 
growth of malignant cells, when added 
to the methods of surgical and radio- 
logical treatment, have greatly altered 



the clinical course of leukemia and 
other malignant diseases in children. 
The development of ACTH and corti- 
sone and its derivatives have intro- 
duced a new group of hormonal drugs 
which have far-reaching effects on 
metabolism and in the control of in- 
flammatory diseases. Synthetic diets 
can now be constructed to avoid the 
biochemical blocks which heredity has 
erected in the path of development for 
some unfortunate babies, and as a re- 
sult, a few forms of mental retardation 
can now be prevented if early recog- 
nition is followed by optimal treat- 
ment. With his ability to dissect the 
chemical processes of life and his 
versatility in constructing new com- 
pounds to affect them, the chemist has 
placed the equivalent of a sharp scalpel 
in the hands of the physician. 

Meanwhile the biologists have not 
been asleep, and basic discoveries in 
virology have provided the means of 
exact diagnosis and often of prevention 
of many of the infections due to vi- 
ruses. Since Dr. John F. Enders' basic 
development of improved tissue cul- 
ture techniques only a few years ago, 
vaccines for poliomyelitis and measles 
have been made available, and the vi- 
ruses causing chicken pox, German 
measles, cytomegalic inclusion disease 
(an important disease in the new- 
born) and a number of other illnesses 
have been discovered. 

Effects on Medical Activities 
These dramatic advances in medical 
science have had a tremendous impact 
upon the health of children as they 
have been applied with increasing skill 
by physicians in the community. The 
result is a very marked change in the 
pattern of hospitalization and a shift 
in the problems which occupy the 
major attention of the Hospital Staff. 
These changes would not have oc- 
curred without the scientific advances 



36 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



which made them possible, but they 
are also dependent upon socio-eco- 
nomic developments which provided 
the resources to bring them about — a 
rising standard of living, improved 
housing, and greater availability of 
well-trained general and pediatric phy- 
sicians and of improved community 
hospital facilities in the metropolitan 
area. 

Changes in Hospital Activities 

The effect of these changes upon the 
activities of our Department are high- 
lighted by the following figures for the 
fifteen year period between 1946-47 
and 1961-62: 

Activity Change in 

15 years 



Inc. 



Dec. 
by 



Medical Out-Patient 
Services 

Total Visits to Clinics 80% 
Medical In-Patient 
Services 
Total Admissions 26% 

For short-term care 43% 
For long-term care 40% 

Total Hospital Days 45% 

Short-term care 18% 

Long-term care 72% 

Despite the facts that nearly twice 
as many visits are now being paid to 
the Out-Patient Services and that there 
are very sizeable increases in the num- 
ber of patients being admitted for 
short-term diagnosis or treatment, 
there has been a striking decline in 
hospital days. This is most marked 
for beds devoted to long-term convales- 
cent-type care. These changes seem to 
reflect the following trends: first, de- 
spite the increase in the number of 
pediatricians and pediatric beds in 
other hospitals of the metropolitan 
area, our out-patient facilities continue 
to be used for consultation and our 



wards for the care of sick children in 
large numbers; second, better medical 
treatment has shortened the stay of 
patients in the Hospital; third, better 
housing, increasing appreciation of the 
desirability of keeping a child at home 
with his family, and rising costs have 
all cut down on prolonged hospitaliza- 
tion. 

Further analysis of the changes in 
utilization of the Out-Patient Services 
shows that there has been little change 
in the volume of services rendered by 
our appointment clinics but spectacu- 
lar growth in activity of the Medical 
Emergency Clinic, where patients are 
seen at any time of day or night with- 
out appointment. No figures are avail- 
able for this clinic prior to 1949 when 
there were 3,139 visits. By 1956-57 
this had increased to 5,506 visits, but, 
in the five years since that time, the 
number of visits has increased by 218 
per cent. This appears to be a rather 
general trend in U. S. hospitals. (1) A 
summary of the statistics for the Medi- 
cal Out-Patient Clinics during the past 
five years follows: 

Visits to 
Medical Clinics 



1956-57 1961-62 



Clinic 

Emergency 5,506 17,324 

Child Health Unit 2,839 3,158 
Medical Out-Patient 

Department 17,758 17,799 

Adolescent Unit 4,827 5,331 

Total Visits 30,940 43,612 

A study of this clinic experience 
by two members of our own staff (,) 
shows, as have other such studies, that 
this clinic is not an emergency clinic 
dealing mainly with acutely ill or in- 
jured children, but actually a general 
dispensary to which various types of 
patients come, sometimes from con- 
siderable distances, for a variety of 
reasons. Further study and, possibly, 
change in the services offered by such 



a clinic may be necessary. It is appar- 
ent that many patients mistakenly be- 
lieve they are receiving complete 
pediatric care when they come to a 
clinic designed primarily to meet only 
emergency needs. 

1 Sbortlife, E. C, Hamilton, T. S., and Noroian, 
E. H.: The Emergency Room and the Chang- 
ing Pattern of Medical Care. N. E. J. Med. 
250:20-25, 1958. 

'Bergman, A. B., and Haggerty, R. }.: The 
Emergency Clinic. Am. J. Dis. Child. 104: 
20-25, 1958. 

Changes in Mortality 
During the past year, 171 patients died 
on the various medical wards of the 
Hospital. In 85 per cent of these cases 
post-mortem examination was per- 
formed; this fact is heartening evi- 
dence that these children will not have 
died in vain, but will have contributed 
to the better care of similarly affected 
children in the future. Furthermore, it 
indicates that the fine rapport between 
Hospital Staff and parents continues as 
in the past. The Children's Hospital 
has consistently remained among the 
top ten non-governmental hospitals in 
this country in percentage of post-mor- 
tem examinations, which is taken as an 
important index of hospital standards. 
The actual causes of death have 
changed markedly in recent years, in 
line with national mortality figures. 
Infections, which used to be the major 
cause of death in infancy and child- 
hood, have been largely replaced by 
prematurity, congenital malformations, 
accidents, malignant tumors, and a few 
unsolved chronic diseases. 

Morbidity Today 

Although mortality statistics point to 
die most serious shortcomings of medi- 
cal knowledge or the failure of society 
to put this knowledge to use, morbid- 
ity — or the state of ill health, much 
of it due to so-called minor illnesses — 
occupies most of the physician's time. 
As part of the total complex of facili- 



37 



PHYSICIAN-IN-CHIEF 



ties for the medical care of children in 
the community, the C. H. M. C. plays 
an important role in meeting this bur- 
den of disease. Practicing physicians, 
public health clinics, and community 
hospitals handle the prevention and 
treatment of the majority of ordinary 
illnesses. As a community hospital in 
part, the C. H. M. C. cares for such ill- 
nesses when they occur in patients of 
our Staff members or in patients living 
in this area who do not have a family 
physician. It is important that we con- 
tinue to care for these patients both as 
a community service and for the edu- 
cation of our House Officers. But the 
unique service of our clinics and wards 
is to serve as a resource to assist the 
practicing physician who is faced with 
a diagnostic or therapeutic problem in 
a child with which he cannot deal. 
Thus the patients who come to the 
C. H. M. C. reflect both the prevailing 
trends of morbidity and the inadequa- 
cies of contemporary medical practice. 
They fall into several major categories: 
(a) children suffering from rare, un- 
known, or presently untreatable dis- 
eases; (b) children suffering from seri- 
ous illnesses or handicaps requiring 
highly specialized care; (c) children 
suffering from preventable or treat- 
able diseases who, for one reason or 
another, have not received medical at- 
tention in time to prevent serious dis- 
ease; (d) children suffering from com- 
mon conditions which the practicing 
physician has not been educated to 
deal with (principally disturbances of 
growth, development, behavior, or 
learning); and (e) children suffering 
from conditions which the practicing 
physician has recognized and treated 
properly, but for which he requires the 
backing of a large institution in order 
to satisfy the parents. 

Thus, based upon the kinds of 
patients referred to us today, it would 
seem to be our primary responsibility 



to do the following: (a) to provide ex- 
pert care in new, specialized, and only 
partially explored fields of treatment; 
(b) to develop solutions, through inten- 
sive research, for the unsolved problems 
posed by the remaining life-threaten- 
ing or handicapping diseases and by 
the many disturbances in learning or 
behavior which are so devastating in an 
era when intellectual competence is 
essential to economic security and 
emotional adjustment so necessary to 
both satisfactory performance and per- 
sonal happiness; and (c) to educate 
parents and physicians, so that prevent- 
able disease does not develop as a re- 
sult of negligence or ignorance. 

Organizational Changes and 
Developments at the Hospital 

These great changes in medicine have 
led to a series of new developments 
within the Hospital. These represent 
its adjustment to the responsibilities 
imposed by its traditions and to the 
opportunities for progress in the medi- 
cal care of children presented by the 
advances in medical science and the 
new funds made available for medical 
research since the war. Although this 
report concerns the Medical Depart- 
ment, it should be stressed that many 
of these developments represent the 
combined efforts of several Depart- 
ments and have been the product of 
the joint thinking and planning of 
members of the Department of Medi- 
cine, of the Staff Executive Committee 
and of its Planning Committee, under 
the Chairmanship of Dr. Sidney Far- 
ber. 

The Development of New Services 
Since 1946, a whole series of new 
specialized services has grown up in 
response to the changing needs and 
opportunities in pediatric medicine. 

Cardiology Division 

The brilliant series of advances in the 
surgical treatment of congenital mal- 



formations of the heart and great 
vessels begun by Dr. Robert E. Gross 
in 1938 has challenged the other De- 
partments of the Hospital to provide 
the support which is needed for the 
diagnosis and care of a large group of 
patients who no longer are perma- 
nently handicapped children for whom 
little can be done. During the past 
twelve years the Cardiology Division 
under the leadership of Dr. Alexander 
S. Nadas has gathered a group of phy- 
sicians specializing in cardiology, who 
not only carry an enormous load of 
patient care, but who are actively en- 
gaged in teaching and investigation 
and are attracting top-flight people to 
the C. H. M. C. for training. The Car- 
diac Clinic, which is our second largest 
special medical clinic, and the labora- 
tories and ward services of the Sharon 
Cardiovascular Unit provide a com- 
plete spectrum of activities in this new 
branch of pediatric medicine. The 
far-sighted move by the Trustees of the 
Sharon Sanatorium of combining their 
resources with ours in constructing the 
Sharon ward in The Children's Hospi- 
tal in 1949 has created a splendid 
facility where specially skilled sur- 
geons, physicians, and nurses work as 
a team in the care of the victims of 
congenital heart disease. 

Tumor Therapy Service 
Special facilities for the care of pa- 
tients with disseminated tumors were 
created by Dr. Farber to meet the 
opportunities for specialized treatment 
which appeared when he and his asso- 
ciates first demonstrated that drugs 
could control leukemia in children for 
considerable periods of time. Staffed 
by physicians who hold appointments 
in the Medical Department and or- 
ganized to function as a unit with the 
clinic in the Children's Cancer Re- 
search Foundation, the Tumor Therapy 
Ward of the Hospital has served chil- 
dren with disseminated tumors, and 



38 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



their parents, with both skill and kind- 
ness. 

Neurology Service 

The neurological unit was the first spe- 
cialized medical unit to be developed 
at The Children's Hospital under Dr. 
Bronson Crothers in the 1920's and 
pioneered in the study of children han- 
dicapped by birth injuries or other 
causes. Ably carried along by Dr. 
Randolph K. Byers after Dr. Crothers' 
retirement, its growing importance 
was recognized this year by its organi- 
zation as an independent Department 
of Neurology on July 1, 1962, under 
the distinguished leadership of the first 
Bronson Crothers Professor of Neurol- 
ogy, Dr. L. Lahut Uzman. 

Rehabilitation 

Closely related to Neurology, but cut- 
ting across the activities of many De- 
partments, is the field of rehabilita- 
tion, which comprises the evaluation 
of the handicapped child and the plan- 
ning and establishment of a long-term 
program of care which will enable him 
to realize his maximum potential for 
a productive and satisfactory life. This 
requires the diagnostic and therapeutic 
skills of many different branches of 
medicine and the so-called paramedi- 
cal disciplines. As the pediatrician re- 
sponsible for coordination of interde- 
partmental activities in the manage- 
ment of children with cerebral palsy, 
Dr. William Berenberg has worked 
closely with Dr. Byers in Neurology, 
with Dr. Edith Meyer Taylor in Clini- 
cal Psychology, and with Dr. William 
T. Green and his colleagues in the 
Department of Orthopedic Surgery, 
who have provided great leadership in 
this field through the years, and with 
many other members of the Staff of 
different Departments in the develop- 
ment of a program of rehabilitation. 
It is not an accident that the Cerebral 
Palsy Clinic of the C. H. M. C was 



selected by the American Academy of 
Cerebral Palsy as the best one in which 
to make an evaluation of methods of 
treatment for this condition. This year 
also marks the end of the Cerebral Palsy 
Nursery School, an experimental school 
started in 1950 to develop methods 
for overcoming some of the learning 
handicaps of the cerebral palsied child. 
This school was able to get a consider- 
able number of children ready for en- 
trance into regular schools, and, now 
that its methods have been introduced 
into various educational programs, it 
has completed its mission. 

Psychiatry 

In 1947 Dr. Dane Prugh joined the 
Department of Medicine as the first 
full-time staff psychiatrist in the Hos- 
pital with the support of a bequest 
from the late Harold Brenton. After 
developing a program of teaching, re- 
search, and psychiatric care which 
rapidly outgrew its space and re- 
sources because of the tremendous de- 
mand for psychiatric consultation and 
therapy, the Department of Psychiatry 
was established as an independent 
service under the leadership of Dr. 
George Gardner in 1955. Close rela- 
tions have been maintained between 
the Departments of Medicine and Psy- 
chiatry, and it is hard to see how we 
ever got along without the strong sup- 
port provided by the Psychiatric Staff 
in the care of our patients and in the 
training of our House Officers and 
Fellows in the growing field of psy- 
chological pediatrics. 

Adolescent Medicine 

The original planning for the C M. C. 
called for an extension of our facilities 
to permit the Staff to care for patients 
throughout the full period of growth. 
In order to develop facilities for the 
care of adolescent patients, Dr. J. Ros- 
well Gallagher joined the staff of the 
Department in 1949. The Adolescent 



Unit which he created has now come 
of age. Its example has led to the 
establishment of many similar units 
throughout the country, and it has 
trained many of their leaders. 

Endocrinology 

Few fields of medicine are as basic to 
pediatrics as endocrinology. Growth 
is the fundamental biological process 
which characterizes the healthy child; 
the endocrine glands, under the con- 
trol of the hypothalamic portion of 
the brain, are the regulators of growth 
and of most other metabolic processes. 
Hence it was essential to have a group 
of physicians and scientists working 
in endocrinology if we were to help 
the many children referred to us be- 
cause of disturbances in the growth 
process. Dr. John F. Crigler, Jr., and 
his colleagues, Norman Gold, Ph.D., 
and Jerome Grunt, M.D., Ph.D., have 
created an admirable unit for the care 
of patients and for teaching and re- 
search in this field. We were fortu- 
nate to have access to a considerable 
area of new laboratory space in the 
Good Samaritan Building, permitting 
this valuable development. 

Genetics and Hematology 
In 1946, Dr. Louis K. Diamond was 
receiving a grant of $10,000 per year 
from the Hood Foundation for re- 
search in pediatric hematology and 
had begun to devote most of his time 
to the study and treatment of diseases 
of the blood in children. The develop- 
ment of the Blood Grouping Labora- 
tory to serve the needs of a group of 
Boston hospitals, the organization of 
one of the busiest hospital blood banks 
in the country, and the development 
of an excellent program of research 
and research training in pediatric 
hematology during the past fifteen 
years, when Dr. Diamond has also 
served as Associate Chief of the Medi- 
cal Service and carried a large share 



39 



PHYSICIAN-IN-CHIEF 



of the clinical work and teaching of 
the Department, are a tribute to his 
energy and organizing ability. Out of 
his interest in blood diseases and the 
blood group incompatibilities, based 
on hereditary differences between the 
red blood cells of one individual and 
another, has grown a deep interest in 
clinical genetics. He has established 
a well equipped Clinical Genetics Lab- 
oratory in the old Ida C. Smith Build- 
ing, where Dr. Park S. Gerald, this 
year's winner of the Mead Johnson 
Award of the American Academy of 
Pediatrics, and Dr. Mary Louise Efron 
are busily exploring many of the bio- 
chemical manifestations of genetically 
induced diseases. The presence of this 
group in this Department; of Dr. 
George Yerganian, a distinguished 
biologist, in the Children's Cancer Re- 
search Foundation; of Dr. W. Eugene 
Knox in biochemistry at the New Eng- 
land Deaconess Hospital; and of Dr. 
Claude Villee at the Boston Lying-in 
Hospital provides an outstanding 
group of scientists in the Harvard 
Medical area competent in many as- 
pects of human genetics, a field of 
tremendous importance for the future. 

Other Specialized Services 
Other specialized services have de- 
veloped in response to the needs 
for expert care of special groups 
of children — the Seizure Unit, first 
under Dr. William G. Lennox and now 
Dr. Cesare Lombroso, for children 
with epilepsy; the Nutrition Clinic run 
by Dr. Harry Shwachman for the care 
of children with cystic fibrosis, celiac 
disease and other disorders of nutri- 
tion; the Renal Clinic caring for a 
large number of children with nephro- 
sis under Dr. Francis X. Fellers' guid- 
ance; and a very large and active 
Allergy Clinic formerly under Dr. 
Lewis Webb Hill and now directed 
by Dr. Harry L. Mueller. In addition, 
other laboratories offering facilities 



with certain special techniques have 
also been created to provide new re- 
sources for the better care of our pa- 
tients. These include a laboratory for 
protein studies, which has been ex- 
tremely productive under Dr. David 
Gitlin's leadership, and a laboratory 
for respiratory physiology, in which 
Dr. Charles D. Cook and his associates 
have greatly strengthened our ability 
to understand and deal with disturb- 
ances of respiration in children. 

The foregoing summary simply 
indicates the rapid expansion in the 
pattern of services and activities in 
pediatric medicine which have been 
brought about by the advance of medi- 
cal science during the past sixteen 
years. These developments are only 
parts of an over-all pattern. Many of 
these activities cut across departmental 
lines, and are part of the planning and 
development of The Medical Center 
as a whole. None of them could func- 
tion without support from all the other 
Hospital Services, particularly the Di- 
vision of Laboratories and Research, 
the Radiology Department, and the 
supporting services in Maintenance 
and Administration. They would not 
have been possible without new funds 
— training grants and research grants 
from the National Institutes of Health, 
grants from a number of private foun- 
dations, gifts from individual donors, 
and contributions to special units from 
the appropriate voluntary health agen- 
cies. The new services generated by 
these funds are the life-blood of the 
Hospital. It is their availability which 
brings patients to the Hospital, their 
activities which attract funds to its 
support, and their success which ulti- 
mately creates problems for the Hos- 
pital by eliminating or simplifying the 
treatment of those diseases which used 
to fill our wards and clinics. 

The Disappearance of Old Services 
Medicine has been described as a pro- 



fession which is trying to do away 
with itself. There is still a long way 
to go before we can achieve this pro- 
fessional goal, but there have been 
some notable reductions in certain 
services of the Hospital. 

Poliomyelitis 

Dr. Enders joined the Division of Lab- 
oratories and Research in 1947 at Dr. 
Farber's invitation, and established the 
Research Division of Infectious Dis- 
eases. In 1949, with Robbins and Wel- 
ler, he announced the successful prop- 
agation of the poliomyelitis virus in 
tissue culture by a technique eminently 
suited to growing viruses for the prep- 
aration of vaccine. In 1954 the Salk 
vaccine was introduced on a mass trial 
basis, and in the summer of 1955 
Massachusetts had its worst polio epi- 
demic since 1916. One thousand, two 
hundred fifty patients with poliomyeli- 
tis were admitted to the C. H. M. C 
that summer. Since that dreadful 
summer, the disease has slowly de- 
clined. Last year we saw no proven 
cases of poliomyelitis on our wards. 
This change not only has had an imme- 
diate impact upon the Medical De- 
partment, but will obviously alter the 
case load in Orthopedic Surgery and 
Physiotherapy over the coming years. 
To the casual observer, however, there 
is no evidence that the work load of 
the latter groups has diminished. De- 
spite the striking decline in cases of 
poliomyelitis, there are many other 
crippling conditions which require 
treatment. 

Contagious Diseases 

The Isolation Building was constructed 
in 1929 to provide two floors of iso- 
lation facilities for the care of chil- 
dren with contagious diseases. In 1949 
this building was enlarged by the con- 
struction of three more ward floors 
above the original two, and the seventh 
or top floor was designed to provide 



40 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



facilities for the care of patients re- 
quiring stria isolation — almost en- 
tirely poliomyelitis in the summer and 
falL When the Farley Building was 
constructed in 1956, this seventh floor 
ward was incorporated into the general 
Medical Service. Today there are sel- 
dom more than one or two patients 
requiring stria isolation for contagious 
diseases, although isolation facilities 
are required at times for the care of 
patients infeaed with bacteria which 
have become resistant to the widely 
used antibiotic drugs. 

Rheumatic Fever 

A diagnosis of rheumatic fever in a 
child fifteen years ago frequently 
meant hospitalization for from four 
to twelve months; many of these chil- 
dren, who had to be rehospitalized for 
recurrences of their disease in succeed- 
ing years, developed increasingly se- 
vere heart disease from these recur- 
rences. Although there is no evidence 
that the number of first attacks of rheu- 
matic fever has declined greatly dur- 
ing the past ten years, the duration of 
the initial attack has been shortened, 
and rheumatic fever recurrences have 
beeni almost totally eliminated by peni- 
cillin prophylaxis. The result is a tre- 
mendous decline in the number of days 
of hospitalization and a marked altera- 
tion in the pattern of the disease. 

Care of Children in the Hospital 
Were the Hospital to be revisited 
today by a physician who had worked 
there forty years ago, he would be 
horrified to find parents in the Hos- 
pital every day and possibly one or 
two parents sleeping in. He would 
find a slight disorderliness reminiscent 
of home in most of our patients' 
rooms, would discover a number of 
children from different wards finger 
painting or playing with water, clay 
or other materials together in one of 
the ten play or occupational therapy 



rooms scattered through the Hospital, 
or he might come upon a group of 
children eating together, family style. 
Even as recendy as fifteen years ago, 
parents were only allowed to visit their 
children for two hours on Saturday 
afternoons for fear of bringing in in- 
fections, and patients were seldom 
allowed to mingle with one another 
because of the danger of cross- 
infeaion. There was good reason to 
fear the transmission of infections, be- 
cause there was no way to treat them. 
Consequently, although the kindness 
and TLC (tender, loving care) needed 
by infants and small children was dis- 
pensed as abundantly as possible by 
doctors and nurses at The Children's 
Hospital, the psychological needs of 
the children for companionship and 
for the support of their parents had 
to be sacrificed for their physical pro- 
teaion. The advent of protective vac- 
cines, gamma globulin, and anti- 
microbial chemotherapy has reduced 
the risks of infeaion to the point 
where, so long as we carefully isolate 
those children who are harboring dan- 
gerous organisms until their infeaion 
is controlled, and we surround par- 
ticularly vulnerable patients, such as 
premature infants, with proteaive 
barriers, it is possible to meet the 
psychological and emotional needs of 
our patients to a considerable extent. 
The development of an adequate 
play program in the Hospital goes 
back a long way to the neurological 
unit organized by Dr. Crothers, to the 
group programs in the old orthopedic 
ward, and to the establishment of the 
Brenton Unit for psychological pedi- 
atrics on the Medical Service under 
Dr. Prugh in 1948. The latter organ- 
ized a study of ward management for 
patients from two to twelve years of 
age in an effort to see whether bene- 
fits were to be derived from a program 
aimed at meeting children's psychologi- 



cal as well as physical needs in the 
Hospital. The study clearly demon- 
strated that, for younger children par- 
ticularly, such a program helped the 
child to tolerate hospitalization with 
less evidence of emotional disturbance 
during the hospital stay and after dis- 
charge than was the case with the con- 
ventional hospital routine. C3> The key 
to the program was an experienced 
Nursery School teacher, Miss Staub, 
who understood young children and 
their needs, but it required the full 
support of nurses and medical Staff 
to be effeaive. 

s Prugh, D. G., Staub, E. M., Sands, H. H., 
Kirschbaum, R. M., and Lenihan, E. A.: A 
Study of the Emotional Reactions of Children 
and Families to Hospitalization and Illness. 
Am. J. Orthopsychiatry XXIII:70, 1953. 

Since moving into the new build- 
ing in 1956, with its abundant play 
space, the Department of Patient Edu- 
cation and Recreation has slowly de- 
veloped and grown until it is now 
organized very effectively under Mrs. 
Barbara Patterson's leadership and 
with the guidance of a special com- 
mittee of the Staff. Important as is 
play for its own sake, it provides an 
opportunity for the child to relieve his 
inevitable anxieties and frustrations 
through construttive forms of self- 
expression and thus is an important 
part of the total treatment program. 
There is much still to be done along 
these lines, for example, in some cases 
bringing parents more fully into the 
treatment program, and improving the 
ways in which food is served to chil- 
dren. Nevertheless, the change in the 
atmosphere of the Hospital in this re- 
gard over a fifteen-year period is 
striking. 

Changes in the Educational Program 
A few years ago a former Children's 
Hospital alumnus wrote an editorial 
about what he called "The New Pedi- 
atrics," which gave rise to much dis- 



41 



PHYSICIAN-IN-CHIEF 



cussion about the future of pediatrics. 
In the course of this discussion it be- 
came apparent that a certain number 
of practicing pediatricians were un- 
happy with their lot — primarily be- 
cause their training in a university hos- 
pital for careers as specialists had not 
fitted them adequately for the family- 
type of pediatric practice in which they 
found themselves upon completion of 
their highly specialized training. 

The development of pediatrics in 
The Children's Hospital Medical Cen- 
ter has gone further and further along 
the path of specialization. This is a 
natural outgrowth of the advance of 
knowledge through research. As more 
is learned, the segment of knowledge 
which one human brain can master and 
use becomes narrower and narrower. 
Breadth must be sacrificed for depth. 
However, this need not and should 
not mean that the specialist in pedi- 
atric medicine or surgery cannot deal 
in a comprehensive and effective man- 
ner with the general needs of a sick 
child. 

However, in the practice of pedi- 
atrics in the community, the pediatri- 
cian is a general practitioner; he must 
supervise the health of his patients, 
treat a large number of minor illnesses, 
and serve as a family counsellor, par- 
ticularly in regard to many phases of 
the physical, intellectual, and emo- 
tional development of the growing 
child. As the person with the power 
to save life, particularly during the 
most helpless portion of the life span 
of the individual, he is in a particularly 
strategic position in this role of coun- 
sellor during the critical first five years, 
before the child enters school. It is 
during this period that much of the 
personality structure of the individual 
is formed and that handicaps should 
be recognized and dealt with as effec- 
tively as possible. How is the future 
practitioner to be trained for his role? 



This is a problem with which 
every pediatric educator is faced. We 
have developed an approach based on 
the concept that there is a body of 
knowledge, derived both from the be- 
havioral sciences (psychology, an- 
thropology, sociology), and from such 
disciplines as epidemiology, which 
gives real intellectual content to a spe- 
cialty of family medicine. Like most 
other specialties, what is not known 
far exceeds what is known, but meth- 
ods are available for studying the prob- 
lems and hence research is possible, 
providing an intellectual challenge for 
the future and the opportunity for 
improving our practices. 

In putting this concept to work 
in the educational program, two ap- 
proaches have been used. First, every 
medical House Officer participates in 
family pediatric practices under super- 
vision. During his stay he is assigned 
several families, whose children he 
cares for as their family pediatrician 
throughout his one, two, or three years 
of service. Moreover, one of his rota- 
tions involves an assignment to the 
Child Health Unit, where he has an 
opportunity to go more deeply into 
the field of social and preventive pedi- 
atrics in intimate association with the 
Staff. Second, throughout his training 
period he has abundant opportunities 
to consult with and learn from pedi- 
atric psychiatrists regarding his own 
particular patients seen on the wards 
or in the Out-Patient Department. 
During the period of out-patient duty, 
this association with psychiatrists is 
particularly close. For those House 
Officers completing their basic pedi- 
atric training, there are fellowships 
available, providing further opportuni- 
ties for one or two years of advanced 
training in ambulatory pediatrics, uti- 
lizing the combined resources of the 
Emergency Clinic, the Medical Out- 
Patient Department, the Adolescent 



Unit, the Child Health Unit and Fam- 
ily Care Program, and the Department 
of Psychiatry. These fellowships have 
been provided by the Children's Bu- 
reau, the Grant Foundation, and the 
National Institute of Mental Health. 
Trainees are not only encouraged to 
increase their knowledge and experi- 
ence in common pediatric problems, 
but to pursue some investigative proj- 
ect. It is our hope that some of those 
who have had this type of training will 
be able to continue some clinical re- 
search in their own practices and thus 
not only add zest to their work, but 
learn to replace the empiricism of so 
much of practice with a more scien- 
tific and critical approach. 

Some of the investigations which 
have been undertaken by Fellows and 
Staff in this program include a study 
of the epidemiology of accidents, a 
study of the reasons for failure of pa- 
tients to keep their appointments with 
the clinic, an investigation into the 
nature of the use of the Emergency 
Clinic, and a study of the development 
of respiratory infections in families. 
Thus the Department has tried to ap- 
proach the problems of medical care 
as a legitimate field for investigation, 
teaching, and specialized training, 
feeling that knowledge about children 
and their diseases will not be of much 
use unless it can be effectively applied 
in the setting of practice. 

A Look Ahead 

After this look at what has happened 
to pediatrics and thus to our Hospital 
over the past fifteen years, we must 
try to project our plans ahead to pro- 
vide the kind of services which will 
utilize our resources most effectively 
for the benefit of children during the 
coming years. As a service Institution, 
we have an obligation to provide to 
children the best possible medical care; 
as a teaching Hospital, to educate phy- 
sicians and other health workers in 



42 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



the most modern techniques of diag- 
nosis, treatment and child care, as well 
as to give them a basic scientific foun- 
dation which will enable them to meet 
the inevitable changes of the coming 
decades; and finally, as a research In- 
stitution, to continue to find solutions 
to those medical problems for which 
no satisfactory form of treatment or 
prevention exists. 

Medical Care 

Our obligation to provide the best 
possible pediatric care is double: to the 
children whom we serve and as an ex- 
ample to the physicians and other 
health workers whom we train. In 
order to do this we must do three 
things: first, strengthen the general 
clinical Staff, whose major function is 
diagnosis and general medical treat- 
ment of sick children; second, develop 
physicians with special skills and in- 
terests to meet the particular needs of 
groups of children who require special- 
ized treatment; and third, improve 
certain physical facilities which are 
essential to the achievement of the two 
preceding goals. 

Strengthening the general clinical 
Staff is an essential step in improving 
our diagnostic and therapeutic services 
— particularly in the ambulatory clinics 
— but on the wards as welL Fifteen 
years ago when there were only a few 
pediatricians in the community, the 
kind of patient referred to our ambu- 
latory clinics was usually one whom 
any pediatrician could handle. Today, 
with at least half of the children in 
this area being cared for by pediatri- 
cians, many of our patients are referred 
for expert diagnostic appraisal to us 
by pediatricians who may have been 
trained in our own Hospital. This re- 
quires us to provide a pediatric con- 
sultant with an unusual breadth of 
knowledge and diagnostic skill, who 
can utilize the extraordinary resources 
of the Hospital for the patient's bene- 



fit. Three groups may possibly be in- 
volved in this function: members of 
the full-time Staff with offices in the 
Hospital, House Officers in training, 
and members of the part-time Staff 
who are practicing in the community, 
but who give some of their time to 
the Hospital. We certainly should add 
one or two more experienced pediatric 
consultants with strong general clini- 
cal interests as rapidly as we can sup- 
port them and find office space for 
them, so that they can spend full rime 
in the Hospital. Second, we should 
increase the training and experience 
in ambulatory care of our House Offi- 
cers. Furthermore, if we are going to 
continue to attract and hold the out- 
standing type of Residents we have at 
present, we will need to provide more 
adequate stipends in the future, es- 
pecially for the more senior men. 
Finally, we need to find better ways to 
use the splendid group of practicing 
pediatricians on the Staff. They make 
an important, in fact an essential, con- 
tribution to our program of education 
and patient care, which we acknowl- 
edge gratefully, and we need to experi- 
ment with ways which will utilize 
their particular talents more effectively 
for the benefit of our patients and 
students, while at the same time giving 
them a greater sense of participation in 
clinical activities, which are both stim- 
ulating and rewarding to them. 

In the development of physicians 
with special skills and interests we are 
continuing the process of specializa- 
tion in pediatrics which has already 
made the Institution great, both in 
care and in teaching. What are the 
fields of medicine where special knowl- 
edge and skills are needed in order to 
provide the best consultative advice and 
treatment? The list of those which 
seem to be essential at present follows : 
neonatal pediatrics; allergy and im- 
munity; infectious diseases; rheumatic 



diseases; dermatology; neuromuscular 
diseases; handicapping diseases and re- 
habilitation; cardiology; pulmonary 
diseases; renal diseases; metabolism 
and endocrinology; nutritional dis- 
eases; hematology; clinical genetics, in- 
cluding congenital malformations and 
inborn errors of metabolism; psycho- 
logical pediatrics, including develop- 
mental disturbances, psychosomatic 
medicine, learning problems, behavior 
problems and mental retardation; so- 
cial pediatrics; and adolescent medi- 
cine. 

It is of interest that every one of 
these special fields is already repre- 
sented by someone on the Staff of the 
Hospital, although not all of them are 
members of the Staff in Medicine nor 
are they all full-time. What are most 
needed to strengthen our activities in 
these special fields are: first, better 
facilities in terms of offices, clinic 
space, and particularly clinical research 
laboratories; second, more opportuni- 
ties for stable full-time positions with 
tenure; and third, more collaboration 
between different Departments in pro- 
viding care and in carrying on clinical 
investigation in these different fields. 
The need for facilities is obvious — 
without them we cannot expect to at- 
tract first-class people to our Staff. This 
need seems likely to be met in the near 
future in the new buildings for ambu- 
latory services and clinical research 
now being planned. The need for 
stable, secure, full-time positions is 
equally obvious. Without such oppor- 
tunities we cannot hold top-flight peo- 
ple. It is to be hoped that, within the 
next few years, it will be possible to 
cut the operating deficit to a point 
which will permit the Trustees to use 
our endowment most productively, as 
a means of stabilizing the positions of 
these essential members of the Staff 
whose work is the "guts" of the Hos- 
pital. 



43 



PHYSICIAN-IN-CHIEF 



A great deal of collaborarion al- 
ready is going on in care and in re- 
search, but much more can be done and 
should be done in the future, since it 
is the cooperative efforts of different 
groups who can bring a variety of 
specialized skills to bear on a patient's 
problem that seem most likely to give 
him the full benefit of what our In- 
stitution has to offer. Furthermore, it 
is likely to be the combination of the 
imaginative ideas of individual labora- 
tory scientists with their systematic 
exploitation by groups of cooperating 
clinical investigators which will make 
the most rapid progress in solving the 
disease problems which lie ahead. Per- 
haps what is most needed is better 
communication between those working 
in different Divisions and Depart- 
ments of this Hospital and with those 
in the various departments of the Har- 
vard Schools of Public Health and 
Medicine and the associated hospitals. 
All our planning should be aimed at 
maximizing opportunities for informal 
contacts between members of the Staff. 
It is to be hoped that the new Doctors' 
Dining Room will be a first impor- 
tant step in this direction. Out of such 
informal contacts, when problems of 
mutual interest are discussed, grow 
many of the most fruitful collaborative 
projects. 

Physical facilities do not make an 
institution, but their lack or poor 
quality can hold back a vigorous one. 
This is what is happening to The 
Children's Hospital Medical Center at 
present. As far as the Department of 
Medicine goes, each year makes our 
needs increasingly clear. 

The greatest clinical need is for 
improved facilities for Ambulatory 
Services. These out-patient services are 
the Hospital's face to the community. 
Through them the Institution serves 
most of the patients who come to it 
for help; through them pass those pa- 



tients whose illnesses are of such a 
nature that they require in-patient 
care; and in them are carried on those 
long-term programs of care which per- 
mit us to make advances against the 
increasing proportion of chronic dis- 
ease problems with which we are faced. 
A desperate need is for better and 
larger emergency clinic facilities where 
pediatricians and surgeons may work 
together in the diagnosis of acutely 
ill children. Clinic areas must be 
planned so as to permit flexible use at 
different times for different purposes, 
to provide care for both private and 
Staff patients, and to bring together 
groups such as pediatricians, psychia- 
trists, psychologists, and social workers 
in a diagnostic clinic or the various 
specialists concerned in rehabilitation 
or in evaluation of children with com- 
munication disorders. 

The Family Care Unit, which is 
presently well housed in the old Brace 
Shop building, should ultimately be- 
come more centrally located in the fa- 
cilities of the proposed hospital 
complex, since it involves the staff of 
the different hospitals concerned. 

Equally urgently needed is space 
for clinical investigation. Research is 
the spearhead of our program. It is 
through clinical research that we are 
able to offer better care to patients, it 
is through opportunities for research 
that we can attract outstanding young 
people for training and to Staff posi- 
tions, and it is our research activities 
which attract the funds which support 
so much of our work. At present our 
facilities for clinical research are scat- 
tered, crowded, and often inadequate. 
They need to be brought together in 
close proximity to the patients they are 
to help and in such a way as to pro- 
mote interdepartmental contacts and 
collaboration. And finally they need to 
include not only offices and labora- 
tories, but a clinical research ward area 



where patients from any Service can 
be studied intensively and, conse- 
quently, better treated. 

For medical ward areas, two devel- 
opments are needed which dovetail 
closely with plans for the proposed 
hospital complex: a special ward area 
for the care of the newborn and an 
adolescent ward. The former is a 
natural joint enterprise with the Bos- 
ton Lying-in Hospital, the latter a 
natural cooperative venture with the 
Peter Bent Brigham Hospital. 

Teaching Physicians 
The educational opportunities which 
we can offer to physicians depend 
basically upon the quality of the Staff 
and their research. Our educational 
program already operates for several 
levels of educational experience: for 
Harvard Medical students, for House 
Officers in general pediatric training, 
and for Fellows in advanced training in 
special fields. These educational pro- 
grams are going well and, judging by 
the high quality and number of appli- 
cants for internships, residencies, and 
fellowships, are successful. There is 
room for, and always are, constant 
efforts at improvement. Beyond these 
programs, most of us feel strongly that 
we have a major responsibility for the 
continuing education of those in prac- 
tice, so that they may be kept abreast 
of the rapid advances in pediatrics. A 
short intensive course given by mem- 
bers of the Staff and lasting five days 
was organized two years ago by Dr. R 
Cannon Eley at the suggestion of the 
Staff Executive Committee, and has 
proved very successful. This will be 
given for the third time this winter 
and seems firmly established as an an- 
nual attraction for practicing pedia- 
tricians from all over the country. 
Other methods for keeping the man in 
practice abreast of the progress of 
pediatrics need to be studied. 



44 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Teaching Parents 

The Hospital has done many things 
to educate parents in health matters 
through its Accident Handbooks , 
through booklets put out by the De- 
partment of Public Information to 
which Staff members have contributed, 
and through group therapy sessions. 
Here too is a public service which is 
much needed, and where considerably 
more might be done. Too many chil- 
dren still come to us without proper 
immunization or with a disease which 
could have been prevented, had the 
parent appreciated how potentially 
serious it was and called the doctor 
earlier. 

Research 

Research, in a clinical Department, 
should start from problems presented 
by patients and be primarily aimed at 
giving us a better understanding of a 
disease in scientific terms and thus of 
improving our chances of control of 
the disease process. Clinical investiga- 
tion has two major objectives: first, 
to improve the care of the patient; and 
second, to utilize the unique opportuni- 
ties often presented by patients to ex- 
tend our fundamental knowledge. 
Thus it is both applied science and 
basic science. 

Since clinical investigation is 
dependent upon advances in the basic 
medical sciences for the techniques and 
concepts which it must adapt to the 
study of patients, the clinical investi- 
gator must maintain close contact with 
the particular basic sciences which pro- 
vide the intellectual and technical un- 
derpinning for his work. There are 
many different ways to achieve this, 
from periodic leaves of absence to 
work in a basic science laboratory, to 
having a basic scientist closely asso- 
ciated with the clinical investigative 
group. The way it is done matters 
little, as long as there is frequent and 
free communication. 



During the coming period, the 
research interests of the Medical Staff 
will probably be built around certain 
techniques and basic fields of scientific 
interest which promise to provide a 
fruitful approach to major clinical 
problems. These should not be thought 
of as purely medical laboratories but 
as centers of research interest, where 
workers from any Department who 
wish to use the techniques and facili- 
ties may get expert help in the co- 
operative solution of clinical problems. 
These are the following: 

Clinical Genetics, with particular em- 
phasis upon human cytogenetics and 
biochemical genetics. 

This field of investigation is concerned 
with the pathogenesis of congenital 
malformations, inborn errors of me- 
tabolism, and familial susceptibility to 
many different diseases. Thus it will 
be a necessary part of studies on con- 
genital heart disease, clinical hema- 
tology, mental retardation and many 
other neurological diseases, as well as 
on diabetes, rheumatic fever and other 
diseases where there is a strong familial 
element. Its potential contributions ait 
across the interests of every clinical 
department, and thus its full develop- 
ment will ultimately require a large 
amount of space. 

Biochemistry and Metabolism 

Closely linked with genetics is bio- 
chemistry, which has become the major 
tool of medical research. Clinical ap- 
plications of biochemistry enter into 
studies in the following broad fields: 
genetics, inborn errors of metabolism; 
endocrinology, the regulation of 
growth and metabolism; renal disease 
and electrolyte metabolism; diseases of 
bone; diseases of skeletal and cardiac 
muscle; cystic fibrosis and other nutri- 
tional diseases; and clinical pharma- 
cology. 



Physiology 

Physiological techniques continue to be 
extremely valuable in the study of 
disease. They are of particular impor- 
tance in the following clinical fields: 
cardiology, where there is close inte- 
gration between both medical and sur- 
gical interests; pulmonary disease, in 
which research in medicine, surgery, 
anesthesiology, otolaryngology and or- 
thopedics may come together; renal 
disease, where there is a splendid op- 
portunity for close collaboration be- 
tween medical and surgical investiga- 
tors in dealing with problems arising 
from congenital malformations of the 
urinary tract; and neuromuscular dis- 
eases, a field which is of importance to 
medicine, neurology, and orthopedics. 

Immunology 

The techniques of immunology are 
important in unravelling the responses 
of the host to infectious agents and to 
various sensitizing chemical substances, 
including those derived from the pa- 
tient's own tissues. This is important 
for the investigation of: allergic dis- 
eases; the rheumatic and collagen dis- 
eases; the possibilities of organ trans- 
plantation, of great importance for the 
future of pediatric surgery; and the 
infectious diseases. 

Behavioral Sciences 
Techniques and knowledge from the 
behavioral sciences should make an 
increasingly important contribution to 
pediatrics through the sciences of: 
development, which is concerned with 
the integrated study of psychological, 
neurological, physiological and bio- 
chemical maturation; psychology, 
which is of particular importance to 
the study of learning handicaps and 
behavior disturbances; and sociology, 
which is of particular importance to 
smdies on the provision and effective- 
ness of medical care. 

Although these seem to be the 



45 



PHYSICIAN-IN-CHIEF 



principal foci of research interest for 
the immediate future, the rapid devel- 
opment of new techniques, such as 
those of biophysics, will undoubtedly 
extend these centers of interest in 
many directions which can only be 
dimly foreseen at present. If we are 
to solve the problems which are the 
cause of the greatest morbidity and 
mortality, we must provide access to 
basic scientific thinking and excellent 
laboratory facilities, which will permit 
the application of new techniques to 
old problems, for a group of alert 
scientifically-minded and -trained phy- 
sicians, surgeons, psychiatrists, radiolo- 
gists, and pathologists who are 
competent in the treatment and clini- 
cal investigation of specific diseases. 
Given an opportunity to work in an 
atmosphere of freedom where there are 
frequent opportunities to collaborate 
with and stimulate one another, the 
history of our Institution makes it 
abundantly clear that rapid progress 
will be made toward the ultimate goal 
of turning the Hospital into a center 
far the promotion of health. 

A few personal notes are in order. 
Dr. Clement A. Smith received the 
Borden Award of the American Acad- 
emy of Pediatrics in October, 1961, and 
Dr. Park Gerald received the Mead 
Johnson Award of the same organiza- 
tion in October, 1962. Dr. Robert J. 
Haggerty, who has been on leave of 
absence to study social pediatrics in 
England and Europe during the year 
1961-62 as a Faculty Scholar of the 
Commonwealth Fund, has been named 
a Markle Scholar for the five-year 
period from July, 1962. 

In closing this report, I should 
like to express my appreciation to all 
those Staff members, House Officers, 
nurses, social workers, recreation work- 
ers, technicians, secretaries, and work- 
ers in the administrative services whose 
joint efforts make the Hospital the 



kind of place it is. What it is or 
can be is perhaps best expressed by 
quotations from two letters. The first 
is from a foreign physician as he was 
leaving after a year's training: 

I would like to express to you, 
and all the people of The Chil- 
dren's Hospital, my deepest 
thanks for this great opportunity 
to study and to do research work 
in The Children's Hospital Medi- 
cal Center. Thank you also and 
particularly for the great and 
generous hospitality of the Ameri- 
can people toward me. 

Thank you for all. 

And in another letter, the wife of a 
physician in training whose small boy 
was admitted for emergency care wrote 
as follows: 

This past week our son was a 
patient at Children's. Although 
my husband has worked at The 
Children's Hospital Medical Cen- 
ter for more than a year, my only 
impressions were seen 'thru a 
glass darkly.' I conceived of it as 
a very lofty institution with a 
loftier reputation. I also misun- 
derstood that reputation to be 
based solely on clinical and aca- 
demic excellence. 

I stand corrected and rebuked. 
The entire staff of the Division 
and many others cared for our 
son as if each were his parent. 
Not during one momenr can I 
imagine one thing more anyone 
could have done to ease an upset 
mother or care for a sick little 
boy. 

I feel very grateful and hum- 
ble. Although I've tried to thank 
each person as they helped us, I 
wanted to tell you how completely 
and thoughtfully our son was 
treated and how much I appreci- 
ate everything. 



Because of the length of this re- 
port, no specific reports from the vari- 
ous Divisions will be included this 
time. The list of those who have been 
trained during the past two years and 
the publications of the Department 
give some idea of the great activity 
which has been going on. 

Charles A. Jameway, M.D. 
Physician-in-Chief 



46 



REPORTS OF CHEEFS OF THE MEDICAL SERVICES 



DEPARTMENT OF MEDICINE 

House Staff 

July 1960-June 1961 

INTERNS IN MEDICINE 

Theodore Friedmann, M.D. 
John W. Mitchell, Jr., M.D. 
Kenneth S. Robson, M.D. 
Peter B. Rosenberger, M.D. 
Jon B. Tinglestad, M.D. 

JUNIOR ASSISTANT RESIDENTS 
IN MEDICINE 

Alberto Abadi (Aljanet), M.D. 

William B. Bason, M.D. 10/1/60-12/3 1/60 — 
Chelsea Naval Hospital 

William D. Bradford, M.D. 

Martha A. Carpenter, M. D. 

Stephen Preston Clement, Jr., M.D. 

Carl de Luca, M.D. (Affiliating Junior Assist- 
ant Resident in Medicine for Ambulatory 
Services — from Rhode Island) l/l/61- 
6/3 0/61 

Robert Thomas Dooley, M.D. 4/1/6I-6/30/6I 
— Chelsea Naval Hospital 

Ralph Earle, Jr., M.D. 

Florence Geller, MS). 

John L. Green, M.D. 

James Hughes, M.D. 7/1/60-9/30/60 — 
Chelsea Naval Hospital 

Peter R. Huttenlooher, M.D. 

A. Myron Johnson, M.D. 

Ira Marks, M.D. 

Ann M. Michelson, M.D. 

Denis R. Miller, M.D. 

Beale Hibbs Ong, M.D. 

Ammon Rosenthal, M.D. 

SENIOR ASSISTANT RESIDENTS 

IN MEDICINE 

Abraham B. Bergman, M.D. — (On leave of ab- 
sence at St. Mary's in London) 

Edward M. Brett, B.M., B.Ch., M.R.C.P. 
(1/1/61-12/31/61) 

Moon Yong Chung, M.D. 

Gerald M. Fendrick, M.D. 

Jaime L. Freundt-Thurne, M.D. 

Milton S. Grossman, M.D. (to 12/3 l/60) 

Richard A. Katz, M.D. (to Aug. 31, 1960) 

Martin R. Klemperer, M.D. 

Oliver F. Roddey, M.D. 

CHIEF RESIDENT IN MEDICINE 

David Carver, M.D. 

CHIEF RESIDENT IN THE MEDICAL 
OUT-PATIENT DEPARTMENT 
A. A. Douglas Moore, M.B., B.S. 



DEPARTMENT OF MEDICINE 

House Staff 

July 1961-June 1962 

INTERNS IN MEDICINE 
Ralph B. Bell, M.D. 
Bernard Moss, M.D. 
George I_ Robb, M.D. 
David W. Walton, M.D. 
Jordan R. Wilbur, M.D. 

JUNIOR ASSISTANT RESIDENTS 

IN MEDICINE 

Matthew A. BudiJ, M.D. 

Thomas F. Anders, M.D. (Co l/lj/62 when he 

was drafted) 
George W. Brum'ey, M.D. 
Gerald W. Fernald, M.D. 
Theodore Friedmann, M.D. (to l/n/62 when 

he was drafted) 
John W. Mitchell, Jr., M.D. 
Peter S. Rosenberger, M.D. 
Jon B. Tingelstad, MD. 

ASSISTANT RESIDENTS IN 
MEDICINE 

Martha A. Carpenter, M.D. 

Ralph Earle, Jr., M.D. 

Florence Geller, M.D. 

Ghamar Hasheroee, M.D. (l/l/62-6/30/62) 

Ira Marks, M.D. 

Beale H. Ong, M.D. 

Charles E. Burden, M.D. 

Lome K. Garretson, M.D. 

William E. Hodgkin, M.D. 

A. Myron Johnson, M.D. 

Ammon Rosenthal, M.D. 

Denis R. Miller, M.D. (On leave of absence at 

St. Mary's in London) 
Suzanne Brunet, M.D. (Tumor Therapy) 
Sylvio Bernaldo Margulis, M.D. (Tumor 

Therapy) 

RESIDENTS IN MEDICINE 

Edward M. Brett, B.M., B.Ch., M.R.C.P. (to 

12/31/61) 
David H. Smith, M.D. 

Michael J. Tynan, M.D. (1/1/62-6/30/62) 
Pacita J. Mariano, M.D. (Tumor Therapy) 

CHIEF RESIDENT IN MEDICINE 

Robert A. Goodell, MD. 

CHIEF RESIDENT IN THE MEDICAL 
OUT-PATIENT DEPARTMENT 
Joel J. Alpert, M.D. (8/21/61-6/30/62 Act- 
ing Chief Resident in M.O.P.D. 7/l/61- 
8/21/61) 
Ammon Rosenthal, M.D. 



PUBLICATIONS 
July, 1960-June, 1961 

Auld, P. A. M., Kevy, S. V., and Eley, 
R. C, Poliomyelitis in children. Ex- 
perience with 956 cases in the 1955 
Massachusetts epidemic. N. E. J. 
Med. 263/1093, I960 (Dec.). 

Auld, P. A. M., Rudolph, A. J., Avery, 
M. E., Cherry, R. B., Drorbaugh, J. 
E., Kay, J. L., and Smith, C A, Re- 
sponsiveness and resuscitation of the 
newborn. Am. J. Dis. Child. 101: 
713, 1961 (June). 

Bergman, A. B., My year in London. 
WRU School of Medicine, Alumni 
Bulletin, 1961. 

Brazelton, T. B., Psychophysiological 
reactions of the neonate: I. The 
value of observation of the neonate. 
7. Ped. 58:508, 1961 (April). 

Brazelton, T. B., Psychophysiological 
reactions of the neonate: II. The ef- 
fect of maternal medication on the 
neonate and his behavior. /. Ped. 
58:513,1961 (April). 

Bucci, G., Cook, C. D., and Hamann, 
J. F., Diffusion studies in congenital 
heart disease. Federation Proceed- 
ings 20: No. 1, Mar. 1961. 

Bucci, G, Cook, C. D., and Barrie, H., 
with technical assistance of J. F. 
Hamann, Studies of respiratory phys- 
iology in children. V. Total lung 
diffusion, diffusing capacity of pul- 
monary membrane, and pulmonary 
capillary blood volume in normal 
subjects from 7 to 40 years of age. 
/. Pediatrics 58:820, 1961 (June). 

Bondurant, S., Mead, J., and Cook, C. 
D., A re-evaluation of effects of 
acute central congestion on pulmo- 
nary compliance in normal subjects. 
J. Applied Physiology 15:875, I960 
(Sept.). 

Travis, D. M., Cook, C. D., Julian, D. 
G, Crump, C. H., Helliesen, P., 
Robin, E. D., Bayles, T. B., and Bur- 
well, C. S., The lungs in rheumatoid 
spondylitis. Gas exchange and lung 



47 



PHYSICIAN-IN-CHIEF 



mechanics in a form of restrictive 
pulmonary disease. Am. J. Medicine 
29:623,1960 (Oct.). 

Cook, C D., Probable gastrointestinal 
reaction to soybean. N. E. J. Med. 
263:1076, I960. 

Cook, C. D., Pulmonary physiology of 
the newborn infant in health and 
disease. Clinical Cardiopulmonary 
Physiology. Chapter 32, pp. SOT- 
SI 7, 1960. Published by Grune and 
Stratton, Inc. 

Cook, C. D., Wedgwood, R. J. P., 
Craig, J. M., Hartmann, J. R., and 
Janeway, C. A., Systemic lupus ery- 
thematosus. Description of 37 cases 
in children and a discussion of endo- 
crine therapy in 32 of the cases. 
Pediatrics 26:570, I960 (Oct.). 

Cook, C. D., Fetal and Neonatal 
Anoxia. Davis Gynecology and Ob- 
stetrics. Chapter 6, Volume II, pp. 
97-101, I960. 

Cook, C. D., Respiratory problems of 
the newborn. Chapter for the An- 
nual Review of Medicine. 22:369, 
1961. 

Croteau, J. R., and Cook, C. D., Vol- 
ume-pressure and length-tension 
measurements in human tracheal 
and bronchial segments. /. Applied 
Physiology 16:170,1961 (Jan.). 

Cook, G D., The physiology of respira- 
tory problems in newborn infants. 
Biennial Western Conference on An- 
esthesiology, May 1961. (Hollywood 
Convention Reporting Co., Los An- 
geles). 

Crigler, J. F., Jr., Thyrotropic Hor- 
mone (s). Chapter VIII in Hor- 
mones in Human Plasma, edited by 
Harry N. Antoniades. Little, Brown 
and Co., Boston, Mass., I960, pp. 
201-223. 

Gitlin, D., Hughes, W. L., and Jane- 
way, C. A., Absorption and excretion 
of copper in mice. Nature 188:150, 
1960 (Oct.). 

Gitlin, D., and Janeway, C. A., Some 



isotopic studies on the distribution 
and metabolism of plasma proteins 
in Advances in Biological and Medi- 
cal Physics, Vol. VII. Edited by Dr. 
Cornelius Tobias. Academic Press, 
Inc. pp. 249-293, I960. 

Gitlin, D., and Janeway, C. A., Genetic 
alterations in plasma proteins of 
man. Chapter 19 in The Plasma 
Proteins, VoL 2. (F. Putnam, ed., 
Academic Press, N. Y.) I960, pp. 
407-451. 

Gitlin, D., Differences in the primary 
structure of related purified anti- 
bodies. Fed. Proc. 19:199, I960. 

Gitlin, D., Les Agammaglobulinemies 
in Analyse Immuno-Electrophore- 
tique. (F. Grabar and P. Burtin, 
Masson et Cie, Paris), I960, pp. 
151- 

Gitlin, D., Commerford, S. L., Amster- 
dam, E., and Hughes, W. L., X-rays 
affect the incorporation of 5-iodode- 
oxyuridine into deoxyribonucleic 
acid. Science 233:1074, 1961 
(Apr.). 

Gitlin, D., and Merler, E., Similarity of 
peptides in two antigen-combining 
fragments released from a rabbit 
antibody by papain. Nature 190: 
634,1961 (May). 

Gitlin, D, Schmid, K., Earle, D. P., and 
Givelber, H., Observations on 
double albumin. II. A peptide differ- 
ence between two genetically deter- 
mined human serum albumins. /. 
Clin. Invest. 40:820, 1961 (May). 

Gitlin, D, Monckeberg, F., and Jane- 
way, C. A., Effects of pneumococcus 
capsular polysaccharides on the de- 
gradation of rabbit antibodies in 
mice. /. Immunology 86:627, 1961 
(June). 

Glauser, E. M., Cook, C. D., and Bou- 
gas, T. P., Pressure-flow characteris- 
tics and dead spaces of endotracheal 
tubes used in infants. Anesthesiology 
22:559, 1961 (May-June). 

Gross, P. A. M., Certain immunologic, 



clinical, and hypersensitivity mani- 
festations of agammaglobulinemia. 
N. Y. State }. Med. 60:2258, I960 
(July). 

Hanshaw, J. B., and Weller, T. H, 
Urinary excretion of cytomegalovi- 
ruses by children with generalized 
neoplastic disease. Correlation with 
clinical and histopathologic observa- 
tions. /. Pediatrics .58:305, 1961 
(Mar.). 

Janeway, C. A., Infectious disease and 
immunity in early life. Ped. Clinics 
of N. A. (Symposium on Infectious 
Diseases). W. B. Bradford, Consult- 
ing Editor. W. B. Saunders Co., 
Philadelphia. 7:799, I960. 

Janeway, C. A., General summary. 
Scientific Program of Ninth Interna- 
tional Paediatric Congress. /. Pedi- 
atrics 57:125, I960 (July). 

Haggerty, R. J., and Janeway, C. A., 
Evaluation of a pediatric house offi- 
cer program. Pediatrics 26:858, 

1960 (Nov.). 

Janeway, C. A., A physician's view of 
change. In Values and Ideals of 
American Youth. Edited by Eli 
Ginzberg. Columbia University 
Press, pp. 15-25. 1961. 

Metcoff, J., and Janeway, C. A., Studies 
on the pathogenesis of nephrotic 
edema. /. Pediatrics 58:640, 1961 
(May). 

Enders, J. F., Katz, S. L., Milovanovic, 
M. V., and Holloway, A., Studies on 
an attenuated measles-virus vaccine. 
I. Development and preparation of 
the vaccine: technics for assay of 
effects of vaccination. N. E. J. Med. 
263:153, I960 (July). 

Kevy, S. V, and Lowe, B. A., Strepto- 
coccal pneumonia and empyema in 
childhood. N. E. J. Med. 264:758, 

1961 (Apr.). 

Ko, K. W., Yaffe, S. J., Craig, J. M., 
and Fellers, F. X., Structural and 
functional changes in the kidney of 
magnesium deficient rats. CI. Re- 
search 8:229, 1960 (#2). 



48 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Neligan, G. A., and Smith, C. A., The 
blood pressure of newborn infants 
in asphyxial states and in hyaline 
membrane disease. Pediatrics 26: 
735,1960 (Nov.). 
Rosen, F. S., Parathion. N. E. J. Med. 

262:1243, I960. 
Rosen, F. S., Kevy, S. V., Merler, E., 
Janeway, C. A., and Gitlin, D., 
Dysgammaglobulinaemia and recur- 
rent bacterial infection. Lancet: 
April 1, 1961, p. 700. 
Rosen, F. S., The endotoxins of gram- 
negative bacteria and host resistance. 
N. E. }. Med. 264:919 and 980, 
1961 (May). 
Rudolph, A. J., and Smith, C. A., 
Idiopathic respiratory distress syn- 
drome of the newborn. /. Pediatrics 
57:905, I960 (Dec). 
Samartzis, E. A., Cook, C. D., and Ru- 
dolph, A. J., Fibrinolytic activity in 
the serum of infants with and with- 
out the hyaline membrane syndrome. 
Acta Paediatrica 49:727, I960 
(Nov.). 
Samartzis, E. A., and Cook, C. D., The 
relationship between age and fibrin- 
olytic activity of serum. Acta Paedi- 
atrica 49:724, I960 (Nov.). 
Scriver, C. R., Vitamin B6-dependency 
and infantile convulsions. Pediatrics 
26:62, I960 (July). 
Smith, C. A., Informal summary of the 
clinical implications of the proceed- 
ings, pp. 346-352, 1961. Ciba 
Foundation Symposium on Somatic 
Stability in the Newly Born. J. and 
A. Churchill Ltd., London. 
Yaffe, S. J., Craig, J. M., and Fellers, 
F. X., Studies on renal enzymes in a 
patient with renal tubular acidosis. 
Am. J. Med. 29:168, I960 (July) . 

From Adolescent Unit: 

Gallagher, J. R., and Harris, H. I., 

Psychiatry, behavioral problems in 

the adolescent. Annual Review of 
Medicine 11:275, I960. 



Gallagher, J. R., and Seltzer, C. C, 
Maturity ratings and the prediction 
of height of short 14-year-old boys. 
Pediatrics 27:984, 1961 (June). 

Gallagher, J. R., Chapter III (Charac- 
teristics of Children and Adoles- 
cents) in Health Education. Moss et 
al., editors, Washington, D. C, 
National Education Association and 
American Medical Assoc, 1961. 

Gallagher, J. R., Goldberger, I. H., and 
Hallock, G. T., Health for Life. 568 
pp. Boston: Ginn and Co., 1961. 

Allergy: 

Critz, G. T., Evidence for familial al- 
lergy. Ped. 27:45, 1961 (Jan.). 

Cardiology: 

Golniko, R. J., and Rudolph, A. M., A. 
valve for respiratory studies in in- 
fants. Pediatrcis 27:645, 1961 
(April). 

Liebman, J., and Nadas, A. S., The vec- 
torcardiogram in the differential 
diagnosis of atrial septal defect in 
children. Circulation 22:956, I960 
(Nov.). 

Nadas, A. S., Rudolph, A. M., and 
Gross, R. E., Editorial. Pulmonary 
arterial hypertension in congenital 
heart disease. Circulation 22:1041, 

1960 (Dec). 

Nadas, A. S., and Levy, J. M., Peri- 
carditis in children. Am. J. Cardi- 
ology, January, 1961, p. 109. 

Nadas, A. S., Scott, L. P., Hauck, A. J, 
and Rudolph, A. M., Spontaneous 
functional closing of ventricular sep- 
tal defects. N. E. J. Med. 264:309, 

1961 (Feb.). 

Noonan, J. A., Nadas, A. S., Rudolph, 
A. M., and Harris, B. B. C, Trans- 
position of the great arteries. A cor- 
relation of clinical, physiologic and 
autopsy data. N. E. J. Med. 263:592, 
637, 684, 739, I960 (Sept., Oct.). 

Rudolph, A. M. ( Drorbaugh, J. E., 
Auld, P. A. M., Rudolph, A. J., 
Nadas, A. S., Smith, C A., and Hub- 



bell, J. P., Studies on the circulation 
in the neonatal period. The circula- 
tion in the respiratory distress syn- 
drome. Pediatrics 27:551, 1961 
(Apr.). 

Sasahara, A. A., Nadas, A. S., Rudolph, 
A. M., Wittenborg, M. H., and Gross, 
R. E., Ventricular spetal defect with 
patent ductus arteriosus. A clinical 
and hemodynamic study. Circulation 
22:254, I960 (Aug.). 

Vain der Hauwaert, L., and Nadas, 
A. S., Auscultatory findings in pa- 
tients with a small ventricular sep- 
tal defect. Circulation 23/886, 1961 
(June). 

Child Health: 

Haggerty, R. J., Fatal ferrous sulfate 
poisoning. N. E. J. Med. 263:564, 
I960. 

Haggerty, R. J., Bacterial infections in 
the newborn. Ped. Clin, of N. A. 
8:481, 1961. 

Bergman, A. B., and Haggerty, R. J., 
The Emergency Clinic — A Study of 
Its Role in a Teaching Hospital. 
Am. J. Dis. of Child. 104:36-44, 
1962. 

Haggerty, R. J., Family Medicine: A 
Teaching Program for Medical Stu- 
dents and Pediatric House Officers. 
J. Med. Educ. Vol. 37, No. 6, June 
1962 Part I. 

Meyer, R. J., and Haggerty, R. J., Strep- 
tococcal Infections in Families — Fac- 
tors Altering Individual Suscepti- 
bility. Pediatrics, April 1962. 

Meyer, R. J., and Haggerty, R. J., The 
Immunization and Tuberculin-Test- 
ing Status of Certain Selected Fami- 
lies. N. E. ]. Med. 264:344-345, 
1961. 

Meyer, Roger J., Acetysalicylic Acid 
(Aspirin) Poisoning. Am. J. Dis. 
of Child. 102:17-24, 1961. 

Haggerty, R. J., Bacterial Infections in 
the Newborn. Am. J. Dis. of Child. 
102:17-24, 1961. 



49 



PHYSICIAN-IN-CHIEF 



Hematology: 

Allen, F. H., Jr., Blood groups of 
humans. Medical Record and An- 
nals 5 3:291, I960 (Nov.). 

Allen, F. H., Jr., Minimizing transfu- 
sion risks. Mass. Physician 18:10, 
1960 (June-July). 

Dalknan, P. R., and Diamond, L. K., 
Vitamin B 12 deficiency associated 
with disease of the small intestine. 
/. Pediatrics .57/698, I960 (Nov.). 

Gerald, P. S., The abnormal hemo- 
globins, in Advance in Human Ge- 
netics. Edited by L. S. Pentose. J. 
and A. Churchill Ltd. (1961). 

Rausen, A. R., and Diamond, L. K., 
"Enclosed" hemorrhage and neonatal 
jaundice. Am. ]. Dis. Child. 101: 
164, 1961 (Feb.). 

Shahidi, N. T., and Diamond, L. K., 
Testosterone-induced remission in 
aplastic anemia of both acquired and 
congenital types. Further observa- 
tions in 24 cases. N. E. J. Med 264: 
953, 1961 (May). 

House of the Good Samaritan: 

Bondurant, S., Mead, J., and Cook, 
C. D., A re-evaluation of effects of 
acute central congestion on pul- 
monary compliance in normal sub- 
jects. /. Applied Physiology 15:875, 
1960 (Sept.). 

Czoniczer, G, Lees, M., and Massell, 
B. F., Continuation of initial attacks 
of rheumatic fever as a major health 
problem. A study of causes and 
recommendations for control. Proc. 
N. E. Cardiovascular Society 19:12, 
1960-61. 

Czoniczer, G, Burwell, E., Niles, J., 
Reider, R., Robinson, J., and Massell, 
B. F., Clinical observations on the 
diuretic effect of hydrochlorothiazide. 
Am. J. Cardiology 7:396, 1961. 

Jhaveri, S., Czoniczer, G., Reider, R. B., 
and Massell, B. F., Relatively benign 
"pure" mitral regurgitation of rheu- 
matic origin. A study of seventy- 



four adult patients. Circulation 22: 
39,1960 (July). 

Jhaveri, S., Czoniczer, G, Barnet, R., 
and Massell, B. F., Factors affecting 
the prognosis of first attacks of rheu- 
matic fever and subsequent rheu- 
matic heart disease. I. Course of the 
disease during follow-up and role of 
therapy in the acute phase. Proc. 
N. E. Cardiovascular Society 18:15, 
45:1349,1961 (Sept.). 

Joseph, M. C, and Tenckhoff, L., Sinus 
arrhythmia in rheumatic fever. Am. 
Heart J. 61:634, 1961 (May). 

Kaplan, M. H., Meyeserian, M., and 
Kushner, I., Immunologic studies of 
heart tissue. II. Occurrence of bound 
gamma globulin in auricular ap- 
pendages from rheumatic hearts. Re- 
tionship to certain histopathologic 
features of rheumatic heart disease. 
J. Exp. Med. 113:1, 1961 (Jan.). 

Kaplan, M. H., Meyeserian, M., and 
Kushner, I., Immunologic studies of 
heart tissue. rV. Serologic reactions 
with human heart tissue as revealed 
by immunofluorescent methods: iso- 
immune, Wasserman, and autoim- 
mune reactions. /. Exp. Med. 113:17, 
1959-60. 

Massell, B. F., Jhaveri, S., Czoniczer, G, 
and Barnet, R., Treatment of rheu- 
matic fever and rheumatic carditis. 
Observations providing a basis for 
the selection of aspirin or adrenocor- 
tical steroids. Med. Clinics of N. A. 
1961 (Jan.). 

Massell, B. F.: (as a member of Rheu- 
matic Fever Working Party of the 
Medical Research Council of Great 
Britain and the Subcommittee of 
Principal Investigators of the Amer- 
ican Council on Rheumatic Fever 
and Congenital Heart Disease, Amer- 
ican Heart Association) . The evolu- 
tion of rheumatic heart disease in 
children. Five-year report of a co- 
operative clinical trial of ACTH, 
Cortisone, and Aspirin. Circulation 
22:503, I960 (Oct.). 



Massell, B. F., Czoniczer G., Jhaveri, S., 
Barnet, R., and Polansky, B. J., Eval- 
uation of steroid therapy in acute 
rheumatic fever. Results of treat- 
ment related to other factors influ- 
encing prognosis, in Mills and Moyer, 
Inflammation and Diseases of Con- 
nective Tissue, Philadelphia and 
London, W. B. Saunders Company, 
1961, pp. 598-610. 

Neurology Division: 

Paine, R. S., Amino acid metabolism 
and mental retardation. Reprinted 
from Mental Retardation. Proc. of 
the First International Conference 
on Mental Retardation. P. W. Bow- 
man and H. V. Mautner, Eds., Grune 
and Stratton, Inc., Publishers. I960, 
pp. 260-271. 

Paine, R. S., Neurologic examinations 
of infants and children. Fed. Clinics 
of N. A. 7:471, I960 (Aug.). 

Paine, R. S., Neurologic conditions in 
the neonatal period. Diagnosis and 
management. Ped. Clin, of N. A. 8: 
577,1961 (May.). 

Pendleton, M. E., and Paine, R. S., 
Vestibular nystagmus in newborn 
infants. A study by visual photo- 
graphic and electrooculographic 
methods. Preliminary report. Neu- 
rology 11:450,1961 (May). 

Seizure Unit: 

Lombroso, C. T., and Forsythe, I., A 
long-term follow-up of acetazola- 
mide (Diamox) in the treatment of 
epilepsy. Epilepsia 1:493, I960. 

Papers published by Members of De- 
partment of Medicine on work car- 
ried out in Division of Laboratories 
and Research. 

Berg, R. B., and Rosentha, M. S., Prop- 
agation of measles virus in suspen- 
sions of human and monkey leuco- 
cytes. Soc. for Exp. Biol, and Med. 
106:581,1961 (Mar.). 

Berg, R. B., and Rosenthal, M. S., 



50 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Studies of fibroblastic cells culti- 
vated from bone marrow of leu- 
kemic and non-Ieukemic patients. 
Soc. for Exp. Biol, and Med. 106: 
614, 1961 (Mar.). 

Berkovich, S., Pickering, J. E., and 
Kibrick, S., Paralytic poliomyelitis 
in Massachusetts, 1959. A study of 
the disease in a well vaccinated pop- 
ulation. N. E. J. Med. 264/1323, 
1961 (June). 

Elian, E., Shwachman, H., and Hen- 
dren, W. H., Intestinal obstruction 
of the newborn infant. Usefulness 
of the sweat electrolyte test in differ- 
ential diagnosis. N. E. J. Med. 264: 
13, 1961 (Jan.). 

Clarke, J. T., Elian, E., and Shwachman, 
H., Components of sweat. Cystic fi- 
brosis of the pancreas compared 
with controls. Am. J. Dis. Children 
101:490, 1961 (Apr.). 

Crocker, A. G., The cerebral defect in 
Tay-Sachs disease and Niemann-Pick 
disease. /. Neurochemistry 7:69, 
1961. 

Crocker, A. G., and Mays, V. B., 
Sphingomyelin synthesis in Nie- 
mann-Pick disease. Am. }. Clin. Nu- 
trition 9/63, 1961 (Jan.-Feb.). 

Ghadimi, H., Clarke, J. T., and Shwach- 
man, H., Simultaneous screening for 
mellituria and aminoaciduria. Cana- 
dian Medical Asso. J. 84/1308, 1961 
(June). 

Green, M. N., Kulczycki, L. L., and 
Shwachman, H., Serum protein 
paper electrophoresis in patients 
with cystic fibrosis. A.M. A. J. Dis. 
Children 200/365, I960 (Sept.). 

Kulczycki, L. L., Mueller, H., and 
Shwachman, H., Respiratory allergy 
in patients with cystic fibrosis. 
/. A. M. A. 27.5/358, 1961 (Feb.). 

Katz, S. L., and Kibrick, S., Nonbac- 
terial infections of the newborn. 
Ped. Clinics of N. A. 8/493, 1961 
(May). 



PUBLICATIONS 
DEPARTMENT OF MEDICINE 
July, 1961-June, 1962 

Bradford, W. D., Cook, C. D., and 
Vawter, G. F., Livedo reticularis: a 
form of allergic vasculitis. /. Pedi- 
atrics 60:266, 1962 (Feb.). 

Brazelton, T. B., Observations of the 
neonate. /. Am. Academy of Child 
Psychiatry 1: No. 1, January, 1962. 

Brazelton, T. B., A child-oriented ap- 
proach to toilet training. Pediatrics 
29/121, 1962 (Jan.). 

Brazelton, T. B., Crying in infancy. 
Pediatrics 29/579, 1962 (April). 

Bucci, G, and Cook, C. D., with techni- 
cal assistance of J. F. Hamann: 
Studies of respiratory physiology in 
children. VI. Lung diffusing capacity, 
diffusing capacity of the pulmo- 
nary membrane and pulmonary capil- 
lary blood volume in congenital 
heart disease. /. Clin. Invest. 40: 
1431,1961 (Aug.). 

Chazen, E. M., Cook, C. D. and Cohen, 
J., Focal scleroderma: /. Pediatrics 
60:585, 1962 (Mar.). 

Clifford, S. H., Barnes, A. C, Bain, 
K., Greenberg, B. G, Potter, E. L, 
and Rosen, F. S., Report of the 
Medical Exchange Mission to the 
USSR on MATERNAL AND 
CHILD CARE. U. S. Department of 
Health, Education, and Welfare. 
Public Health Service Publication 
No. 954, 1962. 

Cook, C. D, and Bucci, G, Studies of 
respiratory physiologoy in children. 
IV. The late effects of lobectomy on 
pulmonary function. Pediatrics 28: 
234, 1961 (Aug.). 

Crigler, J. F., Jr., Cohen, M. I., and 
Wittenborg, M. H, Systemic dis- 
turbances in relation to general and 
dentofacial growth and development 
in children. Am. J. Orthodontics 48: 
1,1962 (Jan.). 

McBride, R. A., Sturgis, S. H, and 
Crigler, J. F., Jr., Gynandroblastoma 



— report of a case with hormonal 
studies. Obstetrics & Gynecology 19: 
814, 1962 (June). 

Crigler, J. F., Jr., and Cohen, R. B., 
Hypoglycemia and convulsions in in- 
fancy. Case records of Mass. Gen. 
Hosp. #38-1962 N. E. J. M. 266: 
1269 (June). 

Crigler, J. F. Jr., Dwarfism and Short 
Stature. Current Therapy. W. B. 
Saunders 1962, pp. 304-305. 

Crigler, J. R, Jr., Cranny, R. L., Wool- 
sey, F. M. (moderator) , UH1, HSM, 
(Edit.). Endocrine Problems in 
Children. Medical Science, Lippin- 
cotts, Dec. 1961. 

Cruchaud, A., Rosen, F. S., Craig, J. M., 
Janeway, C. A., and Gitlin, D., The 
site of synthesis of the 19S gamma- 
globulins in dysgammaglobulinemia. 
7. Exp. Med. 22.5/1141, 1962 
(June). 

Davis, K. K., Hazards to health. Co- 
deine intoxication in infancy. N. E. 
J. Med. 265:592, 1961 (Sept.). 

Earle, R., Jr., Congenital salicylate in- 
toxication — report of a case. Haz- 
ards to Health. N. E. J. Med. 265: 
1003,1961 (Nov.). 

Gitlin, D., and Merler, E., A compari- 
son of the peptides released from 
related rabbit antibodies by enzy- 
matic hydrolysis. /. Exp. Med. 114: 

217.1961 (Aug.). 

Gitlin, D., Rosen, F. S., and Janeway, 
C. A., Undue susceptibility to infec- 
tion. Pediatric Clinics of N. A. 9: 

405.1962 (May). 

Gitlin, D, The hypogammaglobuli- 
nemias. Disease-a-Month. Year Book 
Medical Publishers, Inc. May, 1962, 
pp. 1-40. 

Gitlin, D, and Cruchaud, A., On the 
kinetics of iron absorption in mice. 
7. Clin. Invest. 41:34:4, 1962 (Feb.) 

Gold, N. I., Partial characterization of 
the metabolites of Cortisol-4-C 14 in 
the dog. I. The intact dog. /. Biol. 
Chemistry 236:1924, 1961 (July). 



51 



PHYSICIAN-IN-CHIEF 



Gold, N. I., Partial characterization of 
the metabolites of Cortisol-4-C 14 in 
the dog. II. The totally hepatecto- 
mized dog. /. Biol. Chemistry 236: 
1930,1961 (July). 

Haggerty, R. J., Family medicine, a 
teaching progam for medical stu- 
dents and pediatric house officers. 
]. Med. Education 37:531, 1962 
(June). 

Weller, T. H., and Hanshaw, J. B., Vi- 
rologic and clinical observations on 
cytomegalic inclusion disease. N. E. 
J. Med. 266:1233, 1962 (June). 

Hubbell, J. P., Jr., Drorbaugh, J. E., 
Rudolph, A. J., Auld, P. A. M., 
Cherry, R. B., and Smith, C. A., 
"Early" versus "late" feeding of in- 
fants of diabetic mothers. N. E. J. 
Med. 265:835, 1962 (Oct.). 

Janeway, C. A., Diagnosis of hypogam- 
maglobulinemia. Editorial. J. A. M. 
A. 180:320, 1962 (Apr.). 

Falkinburg, L. W., and Kay, M. N., Vis- 
ceral larval migrans: report of a 
case and review of literature: Arch. 
Pediatrics 29:155, 1962. 

Ko, K. W., Felles, F. X., and Craig, 
J. M., Observations on magnesium 
deficiency in the rat. Lab. Invest. 11: 
294, 1962 (April). 

London, W. L., and Rosen, F. S., An 
Outbreak of Ritter's disease. N. E. }. 
Med. 205:30, 1961 (July). 

Nicolaidou, M., Lund, C. C, and Mc- 
Menamy, R. H., Unbound amino 
acid concentrations in plasma and 
erythrocytes of normal children and 
of cord blood. Arch. Biochemistry 
and Biophysics 96:613, 1962 
(Mar.). 

Nicolopoulos, D. A., and Smith, C. A., 
Metabolic aspects of idiopathic re- 
spiratory distress (hyaline membrane 
syndrome) in newborn infants. Pedi- 
atrics 28:206, 1961 (Aug). 

Rausen, A. R., Cruchaud, A., McMillan, 
C. W., and Gitlin, D., A Study of 
fibrinogen turnover in classical he- 



mophilia and congenital afibrino- 
genemia. Blood 18:710, 1961 
(Dec). 

Remington, J. S., Merler E., Lerner, 
A. M., Gitlin, D., and Finland, M., 
Antibodies of low molecular weight 
in normal human urine. Nature 
194:407, 1962 (April). 

Rosen, F. S., Kevy, S. V., Merler, E., 
Janeway, C. A., and Gitlin, D., Re- 
current bacterial infections and dys- 
gammaglobulinemia: deficiency of 
7S gamma globulins in the presence 
of elevated 19S gamma globulins. 
Report of two cases. Pediatrics 28: 
182,1961 (Aug.). 

Rosen, F., Janeway, C. A., and Gitlin, 
D., Immunoelectrophoretic examina- 
tion of agammaglobulinemia. Nature 
191:1109, 1961 (Sept.). 

Sherry, S. N., Pediatric Practice Prob- 
lems. A symposium on maternal- 
infant adaptation. The Bulletin, Ma- 
ternal and Infant Health, 1962. 

Smith, C. A., Respiratory distress and 
hyaline membranes. (Editorial) 
N. E. J. Med. 265:394, 1961. 

Smith, C. A., Nutritional problems of 
children. Nutrition Reviews 19:353, 
1961. 

Smith, C. A., Prenatal and neonatal 
nutrition. Pediatrics 30:145, 1962. 

Driscoll, S. G., and Smith, C. A., Neo- 
natal pulmonary disorders. Pediatric 
Clinics of N.A. W. B. Saunders Co., 
Philadelphia 9:325, 1962. 

Smith, C. A., The dissemination of 
medical information. Editorial. Pedi- 
atrics 29:689, 1962 (May). 

Driscoll, S. G, and Smith, C. A., Neo- 
natal pulmonary disorders. Pediatric 
Clinics of N. A. 9:325, 1962 (May ) . 

Smith, C. A., Prenatal and postnatal 
gestation in man. Editorial. Pedi- 
atrics 29:1, 1962 (Jan.). 

Van Praagh, R., Causes of death in 
infants with hemolytic disease of the 
newborn (erythroblastosis fetalis). 
Pediatrics 28:223, 1961 (Aug.). 



From Adolescent Unit: 

Gallagher, J. R., The doctor and other 
factors in adolescents' health and ill- 
ness. /. Pediatrics 59:752, 1961 
(Nov.). 

Gallagher, J. R., That favorite teacher: 
a parent's enemy or ally? Marriage 
and Family Living 23: Nov. 1961. 

Gallagher, J. R., Ways to improve your 
treatment of adolescents. Consultant 
40-45 (Dec), 1961. 

Gallagher, J. R., Some aspects of ado- 
lescents' medical care. Postgraduate 
Medicine 31:190, 1962 (Feb.). 

Gallagher, J. R., The physician's role 
in treating adolescent disorders. Feel- 
ings 4:1, 1962 (May). 

Gallagher, J. R., Weight control in ado- 
lescence. /. Amer. Dietetic Assoc. 40: 
519, 1962 (June). 

Gallagher, J. R., Characteristics of Chil- 
dren and Adolescents (The Ado- 
lescent in Secondary School) in 
Health Education, Moss, B. R., et 
al., editors. 429 pp. Washington, 
D. C. National Education Associa- 
tion of U. S., 1961. 

Stults, H., So What's Different About 
Adolescents? in Proceedings of The 
Conference on the Adolescent's 
World: Let's View It. N. Y. Heart 
Association, Inc., N. Y. March 27, 
1962. 

WenzeL B., Stults, H. G, and Mayer, 
J., Hypoferraemia in obese ado- 
lescents. The Lancet 2:327, 1962. 

Allergy: 

Mueller, H. L., The dangers and conse- 
quences of steroid therapy in chil- 
dren. N. Y. State J. Med. 61:2743, 
1961 (Aug.). 

Cardiology: 

Lees, M. H., Hauck, A. J., Stakey, 
G. W. B., Nadas, A. S., and Gross, 
R. E., Congenital aortic stenosis 
operative indications and surgical 
results. British Heart J. 24:31, 1962 
(Jan.). 



52 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Scott, L. P., Hauck, A. J., and Nadas, 
A. S., Endocardial cushion defect 
with pulmonic stenosis. Circulation 
25:653, 1962 (April). 

Child Health: 

Meyer, R. J., Acetysalicylic acid (aspi- 
rin) poisoning. Am. J. Dis. Chil- 
dren 102:17, 1961 (July). 

Meyer, R. J., and Haggerry, R. J., Strep- 
tococcal infections in families. Pedi- 
atics 29:539, 1962 (April). 

Hematology: 

Allen, D. M., and Diamond, L K., Con- 
genital (erythroid) hypoplastic 
anemia — cortisone treated. Am. J. 
Dis. Child. 102:416, 1961 (Sept.). 
Allen, F. H., Jr., Note on the inherit- 
ance of Wr a . Transfusion 1:124, 
1961. 
Walker, Tippett, Roper, Osthoid, 
Munn, Matheson, Lewis, Krabble, 
Gillis, Farrenkopf, Downs, Craw- 
cour, Corcoran, Caspersen, Von 
Bercken, Ball, and Allen, F. H., Jr., 
Tests with some rare blood-group 
antibodies. Vox Sang. 6:357, 1961. 

Bradley, T. B, Jr., Boyer, S. H., and 
Allen, F. H., Jr., Hopkins-2 hemo- 
globin: a revised pedigree and 
blood-serum group data. Bull. Johns 
Hopkins Hosp. 108:75, 1961. 

Corcoran, P. A., Allen, F. H., Jr., Lewis, 
M., and Chown, B., A new antibody, 
anti-Ku (anti-Peltz) in the Kell 
blood-group system. Transfusion 1: 
181, 1961. 

Allen, F. H., Jr., Krabbe, S. M. R., and 
Corcoran, P. A., A new phenotype 
(McLeod) in the Kell blood-group 
system. Vox-Sanguinis 6:555, 1961. 

Allen, F. H., Jr., Independent antigens 
versus independent blood-group 
systems. Editorial. Transfusion 2: 
133, 1962 (May-June). 

Allen, F. H., Jr., and Tippett, P. A., 
Blocking tests with the Rh antibody 
anti-G. Vox Sang. 6:429, 1961. 

Allen, F. H., Jr., and Roseniield, R. E., 
Notation for the Kell blood-group 



system. Transfusion 1:305, 1961 
(Sept.-Oct.). 
Allen, F. H., Jr., Kernicterus. Qu. Rev. 
Pediatrics 16:226, 1961 (Oct.-Dec). 
Allen, F. H., Jr., The Kell blood groups. 
Proc. 8th Cong. int. Soc. Blood 
Trans. Tokyo I960; pp. 131-135. 
Printed in Switzerland, S. Karger 
Basel, New York. (1962.) 
Diamond, L. K., Allen, D. M., and 
MagilL F. B., Congenital (eryth- 
roid) hypoplastic anemia. A 25-yr. 
study. Am. J. Dis. Child. 102:403, 
1961 (Sept.). 
Gerald, P. S., and Ingram, V. M., 
Recommendations for the nomen- 
clature of hemoglobins. /. Biologi- 
cal Chemistry 236:2155, 1961. 
Gerald, P. S, and Efron, M. L., Chem- 
ical studies of several varieties of 
Hb M. Proceedings National Aca- 
demy of Science 47:1758, 1961. 
Gerald, P. S., Efron, M. L., and Dia- 
mond, L. K., A human mutation 
(the Lepors hemoglobinopathy) 
possibly involving two 'cistons'. Am. 
J. Dis. Children 102:514, 1961. 
McMillan, C. W., Diamond, L. K, and 
Surgenor, D. M., Treatment of 
classic hemophilia: the use of fibrin- 
ogen rich in factor VIII for hemor- 
rhage and for surgery. N. E. J. Med. 
265:224 and 277, 1961 (Aug.). 
McCurdy, P. R., Pearson, H., and 
Gerald, P. S., A new hemoglobin- 
opathy of unusual genetic signifi- 
cance. /. Lab. and Clin. Med. 58:86, 
1961. 
Rausen, A. R., Gerald, P. S., and Dia- 
mond, L. K, Haptoglobin patterns 
in cord blood serums. Nature 191: 
717, 1961. 
Rausen, A. R., Gerald, P. S., and Dia- 
mond, L. K., Genetical evidence for 
synthesis of transferrin in the foetus. 
Nature 192:182, 1961. 
Shahidi, N. T, Gerald, P. S., and Dia- 
mond, L. K, Alkali-resistant hemo- 
globin in aplastic anemia of both 



acquired and congenital types. N. E. 
J. Med. 266:117, 1962. 

House of the Good Samaritan: 

Czoniczer, G., Lees, M., and Massell, 
B. F., Streptococcal infection. The 
need for improved recognition and 
treatment for the prevention of 
rheumatic fever. N. E. J. Med. 265: 
951, 1961 (Nov.). 

Massell, B. F., Factors in the patho- 
genesis of rheumatic fever. A study 
of streptococcal infections and rheu- 
matic fever recurrences. J. Maine 
Medical Asso. April, 1962. 

Michael, J. G, Induction of non-speci- 
fic resistance to experimental strep- 
tococcal infection. Clinical Research 
10:218,1962 (April). 

Pelargonio, S., Amezcua, F., Czoniczer, 
G., Szabo, M. A., and Massell, B. F., 
Aortic regurgitation of rheumatic 
origin: clinical course and prognosis. 
Paper presented March 12, 1962. 
Proc. of N. E. Cardiovascular Society 
20:44, 1961-62. 

Neurology: 

Paine, R. S., Symptomatology of un- 
recognized chronic brain syndromes 
in children. J. Maine Medical Asso- 
ciation April, 1962. 

Paine, R. S., Emergencies of cerebral 
origin. Pediatric Clinics of N. A. 
9:67,1962 (Feb.). 

Paine, R. S., Minimal chronic brain 
syndromes in children. Develop- 
mental Medicine and Child Neurol- 
ogy, 4:21, 1962 (Feb.). 

Paine, R. S., On the treatment of cere- 
bral palsy. The outcome of 177 pa- 
tients, 74 totally untreated. Pediatrics 
29:605, 1962 (April). 

Seizure: 

Lombroso, C. T, Epileptic syndromes 
and EEG in inborn metabolic dis- 
orders. VII International Congress 
of Neurology, Rome, September, 
1961. 



53 



PHYSICIAN-IN-CHIEF 



Papers published by Members of De- 
partment of Medicine on work car- 
ried out in Division of Labora- 
tories and Research: 

Enders, J. F., Katz, S. L., and Holloway, 
A., Development of attenuated 
measles-virus vaccines. A summary 
of recent investigation. Am. ]. Dis. 
Child. 103:335, 1962 (Mar.). 

Katz, S. L., Enders, J. F., and Holloway, 
A., The development and evaluation 
of an attenuated measles virus vac- 
cine. Am. }. Public Health 52:5, 
1962 (Feb.). 

Katz, S. L., Morley, D. C, and Krug- 
man, S., Attenuated measles vaccine 
in Nigerian children. Am. J. Dis. 
Child. 103:405, 1962 (Mar). 

Enders, J. F., Katz, S. L., and Grogan, 
E., Markers for Edmonston measles 
virus. Am. J. Dis. Children 103:473, 
1962 (March). 

Mitus, A., Holloway, A., Evans, A. E., 
and Enders, J. F., Attenuated 
measles vaccine in children with 
acute leukemia. Am. J. Dis. Child. 
103:413,1962 (Mar.). 

Yessayan, G., Geiser, C, Silverstone, 
L. E., and Mitus, A., Cytoxan in the 
treatment of acute leukemia in child- 
hood. Proc. Am. Assoc. Cancer Res. 
3:374, 1962 (Abst.). 

Shwachman, H. S., Katz, S., and Kul- 
czycki, L. L., Attenuated measles vac- 
cine in cystic fibrosis. Am. J. Dis. 
Children 103:405, 1962 (Mar.). 



54 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



REPORT OF CHIEF, 
ADOLESCENT UNIT 

In this past academic year the Adoles- 
cent Unit's activities have been carried 
out in a reasonably satisfactory fashion. 
We have been able to retain all but one 
member of our teaching Staff, and have 
obtained an able replacement for him; 
have added two other physicians to our 
Staff; served a somewhat greater num- 
ber of patients than in 1961; have en- 
rolled a particularly cooperative and 
enthusiastic group of postgraduate 
trainees; and have seen a steady in- 
crease in interest in the care of adoles- 
cents in other medical centers. 

Dr. Walter Goodale reluctantly re- 
signed his position with us in Septem- 
ber 1961 because of the press of other 
duties; he has been replaced by Dr. 
Alia C. Zaver, a member of this Hospi- 
tal's Cardiology Division. Dr. Harry 
Stults, a trainee here three years ago, 
has returned on a full-time Staff basis 
to fill the vacancy caused by Dr. Felix 
Heald's transfer to the Children's Hos- 
pital in Washington. Dr. Warren 
Guild, an internist and a member of 
Dr. Thorn's Department of Medicine 
at the Peter Bent Brigham Hospital, 
has joined us as a Consultant in In- 
ternal Medicine; he has a special inter- 
est in such matters as fitness, fatigue, 
and obesity. 

In addition to their teaching 
duties within our Unit, many physi- 
cians on our consultant Staff also 
participate in a variety of teaching 
sessions which affect other physicians' 
understanding of adolescents' medical 
care. They have, for instance, been 
most generous in giving their time to 
such meetings as The Children's Hos- 
pital's Annual Postgraduate Course, the 
New England Postgraduate Assembly, 
and the Massachusetts Medical Soci- 
ety's Postgraduate Medical Institutes. 
With the widespread interest in the 
medical care of adolescents it becomes 
increasingly important for us to main- 
tain this Staff and to offer this type of 



postgraduate instruction. Also, in an 
effort to strengthen our teaching pro- 
gram and to gain a broader community 
understanding of our activities, Mr. 
Sutherland has arranged a series of 
joint meetings with representatives of 
a variety of local social service agencies. 
These have been very successful and 
we intend to continue to include them 
in our regular conference schedule. 

Our research efforts are gradually 
developing into a more satisfactory 
program. The study of auto accidents 
is in its final stages, material regarding 
Serum Iron Levels is being prepared 
for publication, and studies aimed at 
classifying various types of obesity are 
well under way. Attempts begun last 
year to develop satisfactory methods 
for the pre-school screening of little 
children are being continued with the 
cooperation of the Wayland school sys- 
tem. 

At present three new projects 
which should increase our usefulness 
to the community are being planned. 
First, a review of the health needs of 
the Boys' Clubs of Boston: this assess- 
ment, long overdue, has been stimu- 
lated by the extensive changes in the 
Boys' Clubs facilities and programs 
which Boston's urban renewal plans 
have made necessary. Second, we have 
become concerned with the develop- 
ment of an intensive one-week post- 
graduate course in Medical Care of 
Adolescents: this would seem to be 
more practical for, and of greater in- 
terest to, a larger number of practicing 
physicians than our present one-month 
course. And finally, on the basis of 
such experience as we can gain from 
a series of small seminars in coopera- 
tion with the Harvard Graduate School 
of Education and the Harvard School 
of Public Health, we hope to develop 
a year's course for school health per- 
sonnel which would concern itself with 
the problems and practices relating to 



55 



ADOLESCENT UNIT 



the school health program. In addition, 
Dr. John A. Spargo of our Staff has 
accepted a part-time position in the 
Student Health Service at Northeastern 
University; he will continue to direct 
the school health program in Quincy. 

In September 1961 Campus Film 
Productions made a thirty-minute 
color-sound motion picture, "Medical 
Care for Adolescents," for Merck, 
Sharp and Dohme's Public Service 
Series. Most of this was filmed at this 
Unit: the bed-care section was made 
in Dallas at Baylor Medical Center. 
It was first shown at the annual meet- 
ing (November 1961) of the Southern 
Medical Association. The fact that 
Merck has recently felt it necessary to 
order twenty additional copies of this 
film in order to meet its requests indi- 
cates that it has been favorably re- 
ceived. 

During the period from July 1, 
1961 through June 30, 1962 there have 
been 6,341 visits to our Out-Patient 
Department and a total of 814 new 
patients. 

J. Roswell Gallagher, M.D. 
Chief, Adolescent Unit 



Publications 

Gallagher, J. R., The Doctor and Other 
Factors in Adolescents' Health and 
Illness. Journal of Pediatrics 59:752- 
755 (Nov.) 1961. 

, That Favorite Teacher: A 

Parent's Enemy or Ally? Marriage 
and Family Living: XXIII, Nov. 
1961. 

, Ways to Improve Your Treat- 
ment of Adolescents. Consultant: 
40-45 (Dec.) 1961. 

Some Aspects of Adolescents' 



Medical Care. Postgraduate Medi- 
cine 31/190-194 (Feb.) 1962. 
, The Physician's Role in 



Treating Adolescent Disorders. Feel- 
ings 4:1-4 (May) 1962. 
, Weight Control in Adoles- 



cence. /. Amer. Dietetic Assoc. 40: 
519-520 (June) 1962. 
, Chapter III — Characteristics 



of Children and Adolescents (The 
Adolescent in Secondary School) in 
Health Education, Moss, B. R., et al., 
editors. 429 pp. Washington, D. C: 
National Education Association of 
U. S, 1961. 
— , Chapter - The Nature 



of Adolescence (Physiological) in 
Growing Years — Adolescence , 
AAHPER Secondary School Youth 
Yearbook Commission. 320 pp. 
Washington, D. C: National Educa- 
tion Association, 1962. 

Blaine, G. G., Jr., Patience and Forti- 
tude: The Parents Guide to Adoles- 
cence. 206 pp. Boston: Little Brown, 
1962. 

Guild, W. R., How to Keep Fit and 
Enjoy It. 184 pp. New York: 
Harper & Bros., 1962. 

Sloane, A. E., Manual of Refraction. 
Boston: Little Brown & Co., 1961. 

Sturgis, Somers H., et al. The Gyneco- 
logic Patient. New York : Grune & 
Stratton, 1962. 



56 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



REPORT OF PRESIDENT 
OF THE HOUSE OF 
THE GOOD SAMARITAN 

There is little to report on activities of 
the Board of Managers of the House 
of the Good Samaritan for the year 
1962. Our obligations to The Chil- 
dren's Hospital Medical Center have 
been fulfilled and the Research Depart- 
ment has carried on with an active 
program. 

It is with real regret that we 
record the resignation from the Board 
of Mrs. Chilton R. Cabot, because of 
ill health. She was for many years an 
interested, wise, and devoted friend to 
the Hospital. 

Two employees who were pen- 
sioned in 1957 have died: Mrs. Sarah 
G. Hill, for many years the House- 
keeper, and Mrs. Sarah L. Still, who 
came to the Samaritan as Assistant 
Superintendent to Miss Coleman and 
continued in that capacity with Miss 
Hussey. No one fulfilled her position 
more zealously or more devotedly 
guarded the traditions of the Hospital. 

Rose Dougherty and Ben Liese- 
gang have been pensioned by The 
Children's Hospital Medical Center. 
Both gave most willing and devoted 
service over a long period of years. 

It is a satisfaction to realize the 
continuance of a work started over one 
hundred years ago, and to note that, 
with the plans of the C. H. M. C, 
there are exciting opportunities for the 
House of the Good Samaritan. May 
the Managers recognize these oppor- 
tunities and be ready to meet them so 
that the Hospital can continue to con- 
tribute and share in a necessary work, 
for service and the welfare of the com- 
munity. 

Margaret A. Revere 
President 



57 



HOUSE OF THE GOOD SAMARITAN 



REPORT OF CHIEF 
OF HOUSE OF THE 
GOOD SAMARITAN DIVISION 

Since the in-patient facilities of the pital Medical Center in 1958-59, there 

House of the Good Samaritan began has been increasing use of the wards, 

to be operated by The Children's Hos- as shown by the following figures: 

Total Patients Admitted to All Divisions (71, 72, 73, 74) 
Year Admitted Treated Average Census Occupancy 



1956 - 1957 


179 


193 


25 




1957 - 1958 


119 


135 


18 




1958 - 1959 


215 


243 


37 




1959 - 1960 


241 


274 


39 




1960 - 1961 


303 


334 


32 


63.8% 


1961 - 1962 


336 


367 


27 


68.6% 



For the Medical Wards only, ex- 
cluding Division 71, the Respirator 
Unit, which is staffed by the Depart- 



ment of Orthopedic Surgery, the 
ures are as follows: 



Year 


Admitted 


Treated 


Discharged 
202 
245 
262 


Hospital Days 
10,305 
8,166 
8,930 


Average Stay 


1959 - I960 

1960 - 1961 

1961 - 1962 


204 
243 
256 


225 
266 

277 


45.7 days 
33.6 days 
34.5 days 



The Medical Wards' average oc- 
cupancy was 60.5% in 1960-61 and 
66.2% in 1961-62. 

It is interesting to note how con- 
stant the load of rheumatic fever and 
allied diseases has remained through 
the years, as is shown by the statistics 
for the past four years. 

It is clear that patients with rheu- 
matic fever and allied diseases make 
up approximately sixty per cent of the 
load of medical care on the wards, and, 
despite the almost total disappearance 
of cases of recurrent and chronic rheu- 
matic fever that used to fill the House 
of the Good Samaritan, the number of 
patients being admitted for the first 
time with rheumatic fever has not 
changed very strikingly. The occu- 
pancy problems which we have are the 
direct result of medical progress in 
treating the disease once it occurs, 
rather than in progress in eliminating 
the disease altogether. 

The Visiting Staff has not 
changed during the past year. The fol- 



lowing physicians, trainees in Cardiol- 
ogy at The Children's Hospital Medical 
Center, have served as resident physi- 
cians during this past year: Dr. Francis 
F. Nakamura, Dr. Paul G. Hugenholtz, 
Dr. Rajendra Tandon, and Dr. Martha 
A. Carpenter. 

Dr. Benedict F. Massell's report 
will indicate the extent to which the 
remodeled research laboratories have 
been increasingly productive under Dr. 
J. Gabriel Michael's leadership. It is 
through the activities in laboratories 
such as these that the final elimination 
of the threat of rheumatic fever and its 
consequent heart disease will come. 
Even though the magnitude of the 
problem has been diminished by medi- 
cal progress and good follow-up in 
clinics such as ours, this disease re- 
mains a major scourge of children and 
young adults in many countries of the 
world. 

Charles A. Janeway, M.D. 

Chief of House of the 

Good Samaritan Division 



58 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Patients Discharged with Rheumatic Fever and Allied Diseases 

1958-59 1959-60 1960-61 1961-62 



Chorea 11 15 

Rheumatic Fever (with Carditis) 91 (51) 77 (52) 



Rheumatic Heart Disease 


23 


26 


Total, Rheumatic Fever 






and Sequellae 


125 


118 


Suspected Rheumatic Fever 


12 


7 


Total, related to 






Rheumatic Fever 


137 


125 



Post-Streptococcal State 






Disseminated Lupus Erythematosus 


3 


4 


Dermatomyositis and other 






Collagen Diseases 


4 


1 


Rheumatoid Arthritis 


8 


16 


Total, Collagen Diseases 


15 


21 



14 


10 


38 (23) 


53 


42 


53 


94 


116 


3 


10 



97 126 

Subacute Bacterial Endocarditis 5 4 3 

Congenital Heart Disease 3 15 2 

Other Forms of Heart Disease 2 2 
Total, other forms of 

Heart Disease 8 5 10 4 



8 17 

16 24 



Total Discharged, Rheumatic 

Fever and Allied Diseases 160 151 123 



154 



59 



HOUSE OF THE GOOD SAMARITAN 



REPORT OF 

DIRECTOR OF RHEUMATIC 
FEVER RESEARCH UNIT 
AT THE HOUSE OF THE 
GOOD SAMARITAN 

Disease is a biological phenomenon 
with broad ramifications, so that prob- 
lems which at first seem to be con- 
cerned specifically with one particular 
condition are often found to be related 
to many other conditions. So it is 
with rheumatic fever. This fact is 
illustrated by the kinds of studies con- 
ducted at the House of the Good 
Samaritan during the past year. These 
have been concerned not only with 
various clinical aspects of rheumatic 
fever and rheumatic heart disease but 
also with the genetics of disease suscep- 
tibility, the problem of streptococcal 
infection, specific immunity to disease, 
non-specific resistance to infection, 
use and effects of penicillin and other 
antibiotics, and the problem of peni- 
cillin-resistant staphylococci. 

Over the past forty years the 
House of the Good Samaritan has 
collected a vast store of clinical in- 
formation on rheumatic fever and rheu- 
matic heart disease, which to a large 
extent is buried in the records of our 
patients. Some of this information 
has already been tapped, but much 
still remains to be analyzed and evalu- 
ated. In order to utilize the available 
material as effectively as possible, we 
have begun to apply to our problem 
some of the newer data-processing 
methods, and during the past year 
we recorded selected information from 
7,500 patient-admissions on IBM com- 
puter cards. Although this initial pro- 
cedure was designed primarily as a 
foundation on which other studies 
could be builr, it already is providing 
a number of interesting facts about 
the evolving picture of rheumatic fever 
and the possible influence on it of 
changing socio-economic conditions, 
antibiotic prophylaxis, and steroid 
therapy. 

As previous reports have stated, 
the number of ambulatory patients 
attending our clinics has been and is 
steadily increasing. The clinics pro- 



vide essential health services for 
these patients, and the patients 
in turn, provide a unique source 
of clinical material for various re- 
search studies. Since some of the 
studies, such as those concerned with 
the influence of streptococcal infec- 
tion, of rheumatic fever activity, and 
of severity of valvular damage on 
the course of rheumatic heart disease 
are rather complex, we are developing 
methods for the recording of data that 
will allow for the application of com- 
puter techniques to the analysis of our 
clinical material. 

One particular project undertaken 
in connection with the setting up of 
data-processing methods is concerned 
with the evaluation of factors influ- 
encing the prognosis of aortic regur- 
gitation. Since surgical techniques 
for the correction of this rheumatic 
valve lesion are now being rapidly 
developed, it is expected that our 
observations on aortic regurgitation will 
provide a basis for a practical classi- 
fication of patients that will be help- 
ful in their selection for operation. 
A preliminary report of this study 
was recently presented in Mexico 
City in response to a personal invi- 
tation from Doctor Ignacio Chavez, 
President of the Fourth World Con- 
gress of Cardiology. 

The genetic study presently under 
investigation at the House of the 
Good Samaritan is being done to 
learn whether rheumatic fever sus- 
ceptibility is associated with certain 
blood groups and especially to test 
the hypothesis that rheumatic suscep- 
tibility is linked to the genes deter- 
mining whether an individual secretes 
blood group substances into his saliva. 
The project, which is being done in 
collaboration with the Blood Grouping 
Laboratory and the Public Health Serv- 
ice's National Institute of Arthritis 
and Metabolic Disease, requires in- 
dividuals who have had definite rheu- 



60 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



matic fever or who have definite 
rheumatic heart disease and who also 
are married and have children. Since 
the records of our patients provide 
excellent documentation of their rheu- 
matic background, our clinic is an 
unusual source of material for this 
genetic study. 

The Family Program, which was 
inaugurated in 1953, continues to pro- 
vide us with abundant data for both 
clinical and laboratory studies on strep- 
tococcal infection. These studies are 
concerned with the clinical character- 
istics of streptococcal infection, im- 
provement in methods of diagnosis, 
the epidemiology of streptococcal in- 
fections in families, and the problem 
of streptococcal immunity. The prob- 
lem of streptococcal immunity is also 
being attacked in the laboratory where 
an investigation of the relation of 
levels of type-specific antibodies to 
resistance is making good progress. 

Our laboratory studies deal not 
only with type-specific immunity but 
also with the intriguing phenomenon 
of non-specific resistance to infection. 
Two papers on this latter subject have 
been published during the past year. 
In one of the published studies it was 
shown that the injection into mice of 
endotoxin, a substance derived from 
Gram-negative bacteria (such as the 
typhoid bacillus) will make minute, 
normally ineffective amounts of type- 
specific antiserum become highly 
effective in protecting the animals 
against virulent streptococci. This en- 
hancement of a specific immune re- 
action by non-specific stimulation with 
endotoxin can also be demonstrated in 
the test tube by comparing the effect 
on virulent streptococci of whole 
blood derived from endotoxin-treated 
rabbits with that of blood from rab- 
bits who have not received endotoxin. 
The second published report on this 
subject concerns experiments demon- 
strating that certain products of Gram- 



positive bacteria ( such as the group A 
streptococcus) can induce non-specific 
resistance to infection that is equal to 
or even greater than the resistance in- 
duced by endotoxin from Gram- 
negative bacteria. 

Our clinical studies with penicillin 
for the treatment and prevention of 
streptococcal infection and for the 
prophylaxis of rheumatic fever have 
led to laboratory studies dealing with 
the mechanism by which penicillin 
affects streptococcal bacteria. In ex- 
periments now nearing completion it 
has been shown that amounts of peni- 
cillin that are insufficient to kill strep- 
tococci will nevertheless alter the bac- 
teria so that they no longer resemble 
the original parent strains. Thus, sub- 
lethal concentrations of penicillin, act- 
ing on the cell wall of the bacteria, 
cause the organisms to lose their group 
A carbohydrate substance and their 
type-specific protein substance, which 
are the two antigenic components that 
ordinarily allow us to differentiate 
strains of streptococci virulent for man 
from non-virulent strains of strepto- 
cocci. These altered strains, when 
grown on blood agar, frequently also 
lose their typical hemolytic appear- 
ance so that they no longer can be 
distinguished from so-called alpha 
streptococci, which normally ore 
present in the throats of most healthy 
persons. However, when these altered 
streptococci are injected into mice, 
they then regain their original charac- 
teristics, appearing hemolytic on blood 
agar, and producing abundant amounts 
of group A carbohydrate and type- 
specific protein. These laboratory obser- 
vations not only have basic signifi- 
cance but also have potential clinical 
implications. Thus, when penicillin 
treatment seems to eradicate virulent, 
hemolytic, group A strepococci from 
the throats of persons who are ill with 
streptococcal throat infections, we must 
keep in mind the theoretical possibility 



that in some instances die streptococci 
may have been altered rather than 
eradicated. Such altered streptococci 
would not ordinarily be recognized by 
the usual culture techniques, but con- 
ceivably under appropriate conditions 
the organisms might revert to their 
original form and thus might again 
be able to spread to other individuals 
and to cause disease. 

In the course of observations on the 
prevention of rheumatic fever in our 
Family Program we occasionally have 
encountered individuals harboring 
group A streptococci in their throats 
in whom penicillin, even when given 
in large dosage, failed to eradicate the 
bacteria. This experience at first 
seemed puzzling since group A strep- 
tococci are practically always highly 
sensitive to the antibacterial action of 
penicillin. Further investigation sug- 
gested that in many instances the 
failure of penicillin therapy was 
related to the fact that penicillin-resist- 
ant staphylococci were also in the 
throats of these patients. Such organ- 
isms produce penicillinase, which is an 
enzyme that destroys penicillin. Hence, 
these penicillinase-producing bacteria 
might inactivate the penicillin and 
thereby prevent it from eradicating 
the group A streptococci. 

Because of this experience we are 
doing a survey to determine how many 
individuals harbor penicillinase-pro- 
ducing staphylococci in their throats. 
Results available so far suggest that 
the number is large. Furthermore, we 
are investigating methods that pos- 
sibly may be effective in eradicating 
or suppressing these penicillinase- 
producing and penicillin-resistant 
staphylococci. We are also conducting 
other laboratory experiments con- 
cerned with staphylococci and peni- 
cillinase. Thus, our studies on the 
prevention of rheumatic fever have 
led us into the problem of penicillin- 
resistant staphylococci, a problem 



61 



HOUSE OF THE GOOD SAMARITAN 



which constitutes an important chal- 
lenge to present-day medicine. 

Personnel 

During the past year the members 
of the Research Department have 
been Francisco Amezcua, Jacqueline 
Amezcua, Gabor Czoniczer, J. Gabriel 
Michael, T. M. Michael, S. Pelargonio, 
H. Posada, H. Shrand, George P. 
Sturgis, and myself. 

Many of the studies summarized 
briefly in this report could not have 
been done without the modernized 
laboratories and new equipment made 
possible by funds allocated by the 
Managers. For this support, as well as 
for other financial aid, the members 
of the Research Department are 
deeply appreciative and most grateful. 

Benedict F. Massell, M. D. 
Director of Rheumatic Fever 
Research Unit at the House 
of the Good Samaritan. 



Publications 

Streptococcal Infection. The Need for 
Improved Recognition and Treat- 
ment for the Prevention of Rheu- 
matic Fever. Gabor Czoniczer, Mar- 
tin Lees, and Benedict F. MasselL 
New England Journal of Medicine 
265:951-952 (November 9), 1961. 

Factors in the Pathogenesis of Rheu- 
matic Fever: A Study of Streptococ- 
cal Infections and Rheumatic Fever 
Recurrences. Benedict F. Massell. 
The Journal of the Maine Medical 
Association, April, 1962 (Special 
Issue in Honor of Dr. Hans Maut- 
ner's 75th Birthday). 

Aortic Regurgitation of Rheumatic 
Origin: Clinical Course and Prog- 
nosis. Salvatore Pelargonio, Fran- 
cisco Amezcua, Gabor Czoniczer, 
Moshe A. Szabo, and Benedict F. 
Massell. Paper presented March 12, 
1962. In Proceedings of the New 
England Cardiovascular Society 20: 
44-45, 1961-1962. 

Factors Involved in the Induction of 
Non-Specific Resistance to Strepto- 
coccal Infection in Mice by Endo- 
toxin. J. Gabriel Michael and 
Benedict F. Massell. The Journal of 
Experimental Medicine 116:1Q1, 
(July), 1962. 

Induction of Non-Specific Resistance 
to Experimental Streptococcal In- 
fection. J. Gabriel Michael. Clinical 
Research 10:218 (April), 1962. 



62 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



REPORT OF 
NEUROLOGIST-IN-CHIEF 



The personnel of the Neurological 
Service specifically has included Dr. 
R. K. Byers, Chief Neurologist, Dr. 
Richmond S. Paine, Director of the 
M.I.H. collaborative study and three 
or four Fellows annually. During the 
year I960 to 1961 these consisted of 
Dr. John Ross, Dr. Peter Berman, and 
Dr. Robert Pittell. Drs. Ross and 
Berman continued with a year in 
neuropathology under Dr. Betty 
Banker and are now taking a year of 
adult neurology. Dr. Ross is at the 
City Hospital under Dr. Denny- 
Brown and Dr. Berman is at the 
Massachusetts General under Dr. Ray- 
mond Adams. Dr. Pittell is in the 
practice of pediatrics with emphasis 
on neurology in Jacksonville, Florida. 
In 1961-62 the Fellows were Dr. Al- 
berto Abadi, Dr. Arthur Rose, and 
Dr. Robert Hardman and, in addition, 
Dr. Desmond Donovan, who was ac- 
credited to the M.I.H. project and 
worked in the Out-Patient Depart- 
ment and the Seizure Unit with us. 
The Seizure Unit, which was in the 
past separately organized, is now affili- 
ated with the Neurological Service 
under Dr. Cesare Lombroso. In addi- 
tion, we have had two psychologists, 
Dr. Emma Kraidman and Dr. Dorothy 
Day, who were accredited to the De- 
partment of Psychiatry, working in the 
Division of Neurology with particular 
interest in brain damage and its in- 
tellectual implications. Miss Diane 
Livingston has been associated with us 
as social worker, and her investigations 
of the family background and facili- 
ties for the treatment of patients have 
been invaluable. 

The work of the Fellows has in- 
cluded three to four months with Dr. 
Lombroso in the Seizure Unit, three to 
four months with me on the ward 
with in-patient care of neurological 
patients, and three to four months 
working in the Out-Patient Depart- 



ment and giving consultations through- 
out the Hospital for the other Services. 
During the coming year we are plan- 
ning to have the rotation amount to 
three months each and include a period 
with Dr. Donald Matson. 

In June of 1961 I gave two papers 
at a conference sponsored by the Re- 
gional Institute on Neurologically 
Handicapping Conditions in Children 
held at the University of California in 
Berkeley. One was on "Neurologically 
Handicapping Diseases in Childhood" 
and the second on "Recent Advances 
in the Care of Epilepsy." This was 
part of a symposium on brain-injured 
children and what might be done 
about them both medically and educa- 
tionally, and both talks were published 
in the Proceedings. This seemed to me 
a very interesting experience. 

Randolph K. Byers, M.D. 
Acting Neurologist-in-Chief 



63 



NEUROLOGIST-IN-CHIEF 



Publications 

Byers, R. K., M.D., and Betty Banker, 
M.D., "Infantile Muscular Atrophy," 
Archives of Neurology, Vol. 5, Pages 
140 to 164 in August 1961. 

Byers, R. K., M.D., A. B. Bergman, 
M.D., and M. C. Joseph, M. D., 
"Steroid Myopathy," Pediatrics, Vol. 
29, Pages 26 to 36 in January 1962. 

Byers, R. K, M.D., and William T. 
McLean, M.D., "Etiology and Course 
of Certain Hemiplegias with Aphasia 
in Childhood," Pediatrics, Vol. 29, 
Pages 376 to 383, March 1962. 



64 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



REPORT OF NEUROSURGEON- 
IN-CHIEF 



During the year 1961-1962 the Neuro- 
surgical Service has continued to 
expand its activities, functioning as a 
community hospital for the routine 
neurosurgical problems of this area as 
well as a referral and a consultation 
service for special surgical problems of 
the nervous system in children from all 
other parts of this country and abroad. 
The Service has continued to function, 
from a staff and training point of view, 
in close affiliation with the neurosur- 
gical service of the Peter Bent Brigham 
Hospital. 

With the growth of neurological 
surgery, and indeed, of pediatric neuro- 
logical surgery, as independent dis- 
ciplines, there has been something of 
a change in the character of this Serv- 
ice at The Children's Hospital Medical 
Center. Although we continue to act 
as a community hospital for such com- 
mon pediatric neurosurgical problems 
as head and spine injuries, infections, 
congenital anomalies, and intracranial 
and spinal tumors, the size of the 
"community" may be said to have 
shrunk. The reason for this is the 
increased number of facilities and the 
increased number of trained neuro- 
logical surgeons throughout the New 
England area. Whereas our unit prob- 
ably saw a vast majority of all the com- 
mon pediatric neurosurgical problems 
in the New England area ten to twenty 
years ago, there now are at least twenty 
other neurosurgical units and perhaps 
sixty neurological surgeons doing this 
type of work at the present time. This 
decentralization of clinical material to 
smaller and smaller communities 
makes specialized care more quickly 
and widely available to the general 
public. At the same time, it brings up 
certain problems. Many of the ad- 
vantages of concentration of such ma- 
terial in any one clinic and in any one 
surgeon's experience are diminished. 
The lack of concentration of the com- 
moner surgical problems can also be 



a handicap in the operation of a teach- 
ing program. A university hospital 
center such as ours tends, in a specialty, 
to become more and more a referral 
area for complicated and unusual prob- 
lems. Indeed, quite a number of our 
patients are now referred from other 
neurological and neurosurgical special- 
ists for an additional opinion or for 
management of particularly difficult 
and unusual problems. So far, we 
believe the ratio between unusual and 
everyday neurosurgical difficulties has 
been commensurate with a balanced 
Service and a well rounded training 
program. 

From the point of view of nursing 
and other supportive care, as well as 
the special problems which arise in 
the operating room and out-patient 
clinic, maintenance of the integrity of 
a specialized unit devoted to the 
surgical problems of the nervous sys- 
tem in the child is most important. 
However, it is equally important, we 
feel, to insure close continuity with 
the care of these problems through 
adolescence and into adult life. There- 
fore, in the future we would expect to 
continue, and integrate even more 
closely in some ways, our affiliations 
with a neurosurgical unit at the Peter 
Bent Brigham Hospital or in any Har- 
vard University complex which may 
develop. Many of the specialized facil- 
ities, such as operating room electro- 
encephalography, hypothermia and spe- 
cial x-ray equipment, are appropriate 
for all age groups. The future of such 
a combined neurosurgical unit is visual- 
ized as serving patients of all ages and 
providing a well rounded training pro- 
gram, but always with special em- 
phasis on the particular problems of 
early infancy and the growing child. 
In order to allow adequate time 
for staff surgeons to do thoughtful 
teaching, make careful scientific obser- 
vations on their patients, and carry 
out and record clinical and basic in- 



65 



NEUROSURGEON-IN-CHIEF 



vestigations into new fields, in addi- 
tion to the daily care of routine clini- 
cal problems, it seems wise to plan, for 
the years to come, for a staff of at least 
three active neurosurgeons, whose 
primary concern is with patient care 
and teaching and in addition, one or 
two neurosurgeons whose principal 
base of activity will be in the labora- 
tory. It is not anticipated that the 
number of in-patients on the Neuro- 
surgical Service in the future will ever 
greatly exceed the present average of 
twenty to thirty. The average time 
of hospital stay is still decreasing and, 
unless a special unit for the care of 
long-term problems in rehabilitation is 
established, the turnover of patients 
should continue to be relatively rapid. 

We anticipate in the future hav- 
ing three or four career trainees in 
neurosurgery at various levels of ex- 
perience on the clinical service at any 
one time. In addition, beginning this 
year, we have one man from the Neu- 
rology Service attached to our Depart- 
ment to gain experience and to aid in 
the work-up and non-operative aspects 
of the care of surgical patients. Such a 
man also serves as a very useful liaison 
between the two Departments and can 
thereby be helpful to both. One Surgi- 
cal House Officer based at the Brig- 
ham Hospital works closely with the 
Service at all times. In addition, a 
greater part of the year we have one 
fourth year student from the Harvard 
Medical School assigned to our Serv- 
ice. 

The textbook, Neurosurgery in 
Infancy and Childhood, by Dr. Franc 
D. Ingraham and myself, first pub- 
lished in 1954, has continued to be in 
great demand so that a second print- 
ing was necessary in 1962. While most 
of the material in this textbook is still 
accurate and useful, there are new ex- 
periences and new methods which 
should be recorded. It is estimated 
that in perhaps three to four years' 



time a new edition of this textbook 
will be undertaken. In addition, I have 
contributed chapters on pediatric 
neurosurgical subjects to several 
other textbooks: A Textbook of Medi- 
cine, by Cecil & Loeb; Textbook of 
Surgery, by Christopher; Current 
Therapy, 1962, by Conn; and Tumors 
of Childhood, by Ariel & Pack. Chap- 
ters have also been written for two 
new textbooks to be published in the 
near future: The New Harvard Text- 
book of Surgery, edited by Dr. Rich- 
ard Warren, to be published early in 
1963 and A Textbook of Pediatric 
Neurology, editied by Dr. Thomas 
Farmer of the University of North 
Carolina. 

We feel one of the important 
parts of our job is to emphasize to 
pediatricians and general practitioners 
the frequent occurrence of surgically 
treatable lesions of the central nervous 
system in children and to encourage 
their earliest possible recognition so 
that they can be alleviated or cured 
by proper therapy. An example of 
this type of problem concerns the 
neoplasms occurring in childhood 
within the spinal canal Although 
these lesions are not common, they 
occur with great regularity and there 
is probably no condition in which the 
lag between the earliest symptoms and 
the final establishment of the correct 
diagnosis is longer. Such a delay, par- 
ticularly in children with benign, 
slowly growing, intraspinal rumors, 
may be tragic indeed to the eventual 
outcome. It is important therefore, 
to emphasize that unexplained tortic- 
ollis, scoliosis, gait disturbance, ab- 
dominal pain, disturbances of bowel 
and bladder function, or queer vascu- 
lar patterns in the extremities, may 
indeed be the result of a growing 
tumor within the spinal canaL An 
effort is being made, particularly in 
conjunction with the Orthopedic De- 
partment, to improve diagnosis in 



this area. 

Another important area in edu- 
cation relates to intracranial tumors 
in childhood. Few physicians, let 
alone the general public, realize how 
common these are. Aside from the 
neoplasms involving the urogenital 
area, intracranial tumors constitute 
the largest group of neoplasms in 
childhood. Because neurological ex- 
amination in the young child is diffi- 
cult, because the child does not com- 
plain of minor disturbances of 
function early or in an articulate 
manner, there is often a long delay 
again in arrival at the proper diag- 
nosis. Many of the symptoms and 
signs of brain tumor in young chil- 
dren are very non-specific and not 
easily differentiated from those of 
many other more common and tran- 
sient diseases. It is important, there- 
fore, that pediatricians and general 
practitioners suspect the possibility of 
brain tumor on minimal grounds and 
carry out special diagnostic studies 
such as radiography of the skulk elec- 
troencephalography, lumbar puncture 
for examination of spinal fluid, and 
frequently the more elaborate hospi- 
tal studies of ventriculography and 
arteriography. If optimum results in 
treatment are to be obtained, particu- 
larly with the more slowly growing, 
benign, intracranial tumors of child- 
hood (which constitute almost half 
of the tumors seen on our Service) 
the earliest possible diagnosis and 
definitive surgical therapy is impera- 
tive. 

Staff Activities 

During this year, Dr. John Garner 
served as Chief Neurosurgical Resi- 
dent of the combined Children's Hos- 
pital Medical Center and Peter Bent 
Brigham Hospital Service. This 
marked the conclusion of his clinical 
training here and he returned to 
California to practice. Dr. Francis 



66 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Rockett has served during this inter- 
val as Senior Neurosurgical Resident. 
Two men have served for periods of 
six months each as Junior Neuro- 
surgical Resident: Dr. Ronald DiNella 
from Vanderbilt University in Nash- 
ville, Tennessee, and Dr. Glenn Kindt 
from the University of Michigan at 
Ann Arbor. For a period of two 
months, Dr. Hubert Aronson from 
Yale University-Hartford Hospital 
Service attended all the activities of 
the Neurosurgical Service for post- 
graduate experience before entering 
practice in New York City. For a 
period of one month Dr. David 
Klein, a graduate of the Massachusetts 
General Hospital neurosurgical pro- 
gram, did likewise, before beginning a 
staff position at the University of 
Buffalo and the Buffalo Children's 
Hospital. 

Because of the large pediatric 
Neurosurgical unit at the Children's 
and its reputation over the past twenty- 
five years, a good many requests are 
received from other university neuro- 
surgical training programs about the 
possibility of sending a man to our 
unit for periods of six months to one 
year for specialized training in the 
management of neurosurgical condi- 
tions of childhood. This we are not 
often able to do because of the neces- 
sity of carrying our own career Resi- 
dents through the requirements of a 
full training program as outlined by 
the American Board of Neurological 
Surgery and the Council on Medical 
Education and Hospitals of the AMA. 
We do, however, have such men from 
other programs occasionally and feel 
that this experience is a valuable one 
for all concerned. It is a way in which 
the practices and teachings of this 
Department can most effectively be 
passed on to a wider circle of neuro- 
surgeons as these men return to their 
own units. Thus, during the coming 
year, we expect to have on our Serv- 



ice in training capacities at various 
levels: Dr. Erich Wisiol from the Uni- 
versity of Minnesota; Dr. David Kelly 
from Bowman Gray School of Medi- 
cine in Winston-Salem, North Caro- 
lina; and Dr. Ronald Birkenfeld from 
the Mary Hitchcock Clinic at Dart- 
mouth University. 

This past year has been marked 
by the presence of many visitors from 
abroad to the Neurosurgical Service. 
At the time of the International Con- 
gress of Neurological Surgery in 
Washington in October of 1961, we 
had visitors either before or after the 
conference from the following coun- 
tries: England, Scotland, France, Ger- 
many, Switzerland, Italy, Spain, Por- 
tugal, Norway, Sweden, Finland, Den- 
mark, Holland, Belgium, Australia, 
India, Pakistan, Mexico, Venezuela, 
Argentina, Brazil, Peru and South 
Africa. Of particular interest were the 
visits of Professor Kristian Kristiansen 
from Oslo, Norway, who spoke at 
Grand Rounds on his experience with 
hypothermia in operations on the cen- 
tral nervous system, and of Mr. Regin- 
ald Hooper, neurosurgeon to the 
Royal Melbourne and Royal Children's 
Hospitals of Melbourne, Australia, 
who delivered the annual Blackfan 
Lecture on the subject of "Occlusive 
Cerebral Vascular Disease in Child- 
hood." 

This year saw Dr. Franc Ingra- 
ham make an excellent recovery from 
his cardiac illness of April, 1961. His 
presence again in the winter and 
spring of 1962 at neurosurgical con- 
ferences and rounds has been a satis- 
faction and stimulation to all members 
of this Service. 

Dr. John Shillito this year has 
continued and expanded his work 
with cerebral vascular lesions in child- 
hood as a participant in the National 
Study of Extracranial Arterial Occlu- 
sion, sponsored by the Public Health 
Service. The clinical features of 



"strokes" in childhood are being 
studied intensively by arteriographic, 
surgical, and pathological techniques. 
The possibility of applying profound 
hypothermia and microsurgical tech- 
niques to intracranial occlusive vas- 
cular disease in children must be 
further explored. Dr. Shillito has also 
continued as an active consultant at 
the West Roxbury Veteran's Hospital 
and the Pondville Cancer Hospital 
Pediatric neurosurgical problems were 
discussed by Dr. Shillito at staff meet- 
ings of the Worcester City Hospital 
and the Roger Williams General Hos- 
pital in Providence, as well as at the 
annual meeting of the Massachusetts 
Medical Society. 

During the year, I served as Act- 
ing Neurosurgeon-in-Chief and partic- 
ipated in the discussions of the 
Executive and Planning Committees of 
the Hospital I served as Professor of 
Neurosurgery pro tem at the Uni- 
versity of California at Los Angeles for 
one week in February and on my way 
home from that assignment stopped 
in Kansas City to deliver the annual 
Frank Teachenor Memorial Lecture to 
a combined meeting of the Kansas 
City Pediatric and Neurosurgical 
Societies. I continued as secretary of 
the American Board of Neurological 
Surgery, and served as a member of 
two American Medical Association 
committees of the Council on Medi- 
cal Education and Hospitals (the 
Residency Review Committee of 
Neurosurgery, and the Advisory Coun- 
cil for Medical Specialties). I also 
served as one of the two neurosurgical 
members of the Neurological Sciences 
Training Grant Committee of the 
National Institute for Neurological Dis- 
eases and Blindness of the National 
Institutes of Health. 

We must record here with deep 
regret the resignation of Dr. Betty Q. 
Banker as Neuropathologist. She will 
be sorely missed by all members of 



67 



NEUROSURGEON-IN-CHIEF 



the Neurosurgical Service. Her pro- 
vocative teaching conferences, her in- 
fectious enthusiasm in the investiga- 
tion of any form of neurological 
lesion, and her ready and willing 
cooperation whenever consultation was 
sought will be difficult indeed to re- 
place. 

Society meetings at which papers 
were presented during the year in- 
cluded: International Congress of 
Neurological Surgery, "Washington, 
D. C; American College of Surgeons, 
Chicago, Illinois; Harvey Cushing So- 
ciety, Chicago, Illinois; and Massachu- 
setts Medical Society, Boston. Other 
meetings attended by staff members 
included: Society of Neurological Sur- 
geons, Minneapolis; Congress of Neu- 
rological Surgeons, New York; 
American Surgical Association, Wash- 
ington; Association for Research in 
Nervous and Mental Disease, Wash- 
ington; Neurosurgical Society of 
America, Biloxi, Mississippi; New 
England Surgical Society; and Study 
Section of Extracranial Arterial Occlu- 
sions of the Public Health Service, 
Washington, D. C. 

Neurosurgical 
Research Laboratory 

The Neurosurgical Research Labora- 
tory has continued under the direction 
of Dr. Edgar A. Bering, Jr. He has 
had generous support from the Mus- 
cular Dystrophy Foundation and re- 
search grants from the National Insti- 
tute of Neurological Diseases and 
Blindness of the NIH. In addition, 
support of various activities of the 
Research Laboratory, as well as other 
work of the Department, has come 
from the Kent Fund. The generosity 
of the many donors to this fund is 
gratefully acknowledged. 

During the period of this report, 
there were two Fellows working in 
the Laboratory with Dr. Bering: Dr. 
Carl H. Sutton from July 1, 1961 to 



February 28, 1962, and Dr. Osamu 
Sato from July 1, 1961 through June 
30, 1962. Dr. Sutton was on a fellow- 
ship from the Cancer Institute of the 
National Institutes of Health, working 
on growing human neural tumors in 
animals. Dr. Sato is spending his last 
two years in this country on an ex- 
tended period of experimental study 
before he returns to Japan to complete 
his work for a Doctor of Science De- 
gree and to continue in the practice 
of neurosurgery. 

Research was carried out in three 
major areas during the year: first, the 
study of the growth of human neural 
tumors in animals; second, the study 
of the physiology of profound hypo- 
thermia; and third, the study of the 
physiology of cerebrospinal fluid. 

Four different types of neural 
tumors have been transplanted and 
grown in guinea pig eyes from speci- 
mens taken at operation. Two of these 
have been confirmed histologically and 
have been passed through two genera- 
tions of animals. The others are still 
in the first generation and await his- 
tological confirmation of growth. 

The work on the physiology of 
hypothermia has been centered chiefly 
around the technical problems of ex- 
tracorporeal circulation and total body 
cooling, trying to develop ways of get- 
ting higher blood flows and faster 
cooling rates. The use of various blood 
substitutes such as Dextran and plasma 
diluents has been investigated. The 
studies demonstrated that these dilu- 
ents allow much faster circulation in 
the extracorporeal system, but cooling 
rates were increased only in the vis- 
cera and not in the limbs or the head. 
The circulation of the head can be 
improved by increasing the blood 
C0 2 , but this creates many foaming 
problems in the pumping unit and is 
not, at the present time, considered 
desirable. Work is being carried out 
to study the mechanism of the blood 



shunt in the body. Considerable at- 
tention has also been given to the 
problem of the pressure in the left 
heart if a closed by-pass pump sys- 
tem is used, cannulating only one 
artery and the vena cava. It was felt 
from the preliminary observations 
that the pressure in the right heart 
may be of some importance in re- 
starting the heart on warming. These 
studies have been carried out in con- 
junction with the Department of Sur- 
gery. Safe cessation of all circulation 
to the head to allow for surgical 
attack on cerebro-vascular lesions is a 
goal of this type of research. 

The work on cerebrospinal fluid 
physiology has been concerned with 
explanation of the forces causing 
ventricular enlargement in hydro- 
cephalus. These studies, which have 
been going on for the past several 
years, have demonstrated that the force 
causing ventricular enlargement does 
not come from the back pressure of 
obstructed cerebrospinal circulation, 
but rather from the pulse pressure 
generated by the choroid plexus within 
the ventricle as it fills with blood. This 
is a new concept and implies that the 
interpretation of other data must be 
re-evaluated. Further studies have 
been carried out on the formation and 
absorption of cerebrospinal fluid using 
the techniques of ventricular perfusion 
which recently have been developed in 
this country and abroad. These studies, 
while in their preliminary state, sug- 
gest that there is considerable ab- 
sorption of fluid within the ventricular 
system itself, as well as in the sub- 
arachnoid space. 

Dr. Bering attended a special con- 
ference on the use of computers in 
biological investigation which was 
conducted at the Massachusetts Insti- 
tute of Technology this year. This 
conference, sponsored by the National 
Science Foundation, was given to 
twelve scientists whose chief interests 



68 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



were in problems of neurology. It is 

expected that the newer techniques 

soon will be brought to the laboratory. 

Donald D. Matson, M.D. 

Acting Neurosurgeon-in-Chief 



Publications 

Avman, N., and Bering, Jr., E. A. 
A Plastic Model for the Study of 
Pressure Changes in the Circle of 
Willis and Major Cerebral Arteries 
Following Arterial Occlusion. 
/. Neurosurg. 1 8:361-365, 1961 

Bering, Jr., E. A. 

Effect of Body Temperature Change 
on Cerebral Oxygen Consumption 
of the Intact Monkey. 
Amer. ]. Physiol. 200:417-419, 1961 

Bering, Jr., E. A., Bernhard, W. P., 

Schwarz, H. F., and Sutton, C. H. 
Vascular Resistance and Oxygen 
Utilization of the Brain, Heart and 
Whole Body in Profound Hypo- 
thermia. 
Surgical Forum. XIL411-412, 1961 

Bering, Jr., E. A. 
New Advances in the Physiology 
of the Bulk Formation and Flow of 
Cerebrospinal Fluid. 
Excerpta Medica, International Con- 
gress Series. 36.-E54-E55, 1961 

Bering, Jr., E. A. 

Circulation of the Cerebrospinal 
Fluid. Demonstration of the Cho- 
roid Plexuses as the Generator of 
the Force for Flow of Fluid and 
Ventricular Enlargement. 
/. Neurosurgery. X7X.-405-413, 1962 

Matson, D. D., and Salam, Maria 
Brain Abscess in Congenital Heart 
Disease. 
Ped. 27/772-789, 1961 

Matson, D. D. 

Craniocerebral Trauma in Child- 
hood. 
Amer. J. Surg. 101:677-683, 1961 

Matson, D. D., and Shillito, Jr., J. 
Neurosurgical Procedures in the 
Treatment of Neoplastic Disease. 
N. E. J. Med. 263:23-29, 1961 

Matson, D. D. 

Clinical Classification and Evalua- 
tion of Hydrocephalus, Disorders of 
the Developing Nervous System, 
Chapter XVI. W. S. Fields, Editor. 
Charles C. Thomas, 1961 



Matson, D. D. 

Early Shunt Operations for Hydro- 
cephalus. 

Excerpta Medica. International Con- 
gress Series. 36.-E39-E40, 1961 

Matson, D. D. 

Congenital Spinal Defects, Clinical 
Neurosurgery. Proceedings of the 
Congress of Neurological Surgeons, 
Chicago, Illinois, I960, The Wil- 
liams & Wilkins Co. 1961 

Robertson, J. T, Schick, R. W., Mor- 
gan, F., and Matson, D. D. 

Accurate Placement of Ventriculo- 
atrial Shunt for Hydrocephalus un- 
der Electrocardiographic Control. 
/. Neurosurg. 18:255-257, 1961 

Schick, R. W., and Matson, D. D. 
What Is Arrested Hydrocephalus? 
/. Ped. .58:791-799, 1961 

Shillito, Jr., J. 
Management of Head Injuries. 
N. E. J. Med. 26.5:898-900, 1961 

Shillito, Jr., J., and Matson, D. D. 
Sagittal Synostosis: Indications for 
Operation. 
/. Ped. .59:789-790, 1961 

Shillito, Jr., J. 

Indications for Surgery in Cerebro- 
vascular Accidents. 
P. G. Med. 30:537-544, 1961 



69 



ORTHOPEDIC SURGEON-IN-CHIEF 



REPORT OF ORTHOPEDIC 
SURGEON-IN-CHIEF 

The years 1960-61 and 1961-62 have 
been busy and productive. The num- 
ber of cases in the general Orthopedic 
Clinics, in fact, showed a minor decrease 
from the 1959-60 figures, but this 
decrease reflects an increasing percent- 
age of patients in the orthopedic 
offices of the Hospital. The loss in the 
general clinics is made up many times 
by the increasing number seen in these 
areas. 

The in-patient figures for the 
orthopedic wards show a fairly uni- 
form figure over the last three years. 
Those of 1961-62 showed a five per 
cent gain over the preceding year. The 
occupancy rate during this period was 
eighty-two per cent. This cannot be 
called capacity and there are many fac- 
tors other than demand entering into 
occupancy figures. Our orthopedic 
wards are made up largely of rooms 
with several beds. When patients have 
infections or infectious diseases, for 
example, isolation techniques neces- 
sarily reduce the number of beds avail- 
able. Seasonal variation in the admis- 
sion of orthopedic elective procedures 
occurs. It is difficult for a family to 
have their child miss the first part of 
the school year when the procedure 
is such that it could be done just as 
well in the summer. In fact, the first 
part of the school year is the worst 
time for a child to be out of school. 
However, with teachers available in the 
Hospital and better provision for home 
teaching, we are better able to get over 
this hurdle, but it is a real factor in 
the scheduling of admissions. During 
the summer our orthopedic wards are 
often filled to overflowing with pa- 
tients located in other wards and in 
the Good Samaritan convalescent area. 
This fact is not reflected in the census 
figures assigned to our Service, since 
only the figures for the patients on the 
orthopedic wards are given. A further 
factor entering into the lowering of 



occupancy figures is the reduced popu- 
lation over a weekend when all the 
Services of the Hospital are greatly 
reduced. It is well to state in connec- 
tion with this that the Orthopedic 
Out-Patient Department runs on Satur- 
days. 

Teaching 

All third year medical students at Har- 
vard Medical School receive instruction 
in our Department amounting to forty- 
five hours for each student. This occurs 
in sections throughout the school year 
for periods slightly over five weeks. A 
full section is about twenty-five stu- 
dents, but most of the instruction is 
given in small subsections. The use of 
these smaller groups makes instruc- 
tion more effective, but it does require 
more instructional hours and makes an 
increasing demand upon the Staff. 
Other teaching activities of the Medi- 
cal School affect fourth year elective 
students and graduate students enrolled 
in the courses for graduates. 

Responsibilities in teaching in- 
clude those of the physical therapy pro- 
gram of Simmons College in which our 
Chief of Service is Director and Miss 
Shirley Cogland, head of our Physical 
Therapy Department, is Technical Di- 
rector. Many of our Staff participate 
in instruction in this program, as do 
members of other Departments. The 
relation to Simmons College in this 
program greatly strengthens our posi- 
tion in physical therapy. 

Residents 

Our residency training program is one 
of our valuable assets and treasured re- 
sponsibilities. Our program, which is a 
combined one with the Massachusetts 
General Hospital, Peter Bent Brigham 
Hospital, and related hospitals, has a 
very distinguished rating amongst resi- 
dency programs in orthopedic surgery. 
The number of applicants are many 
and we are most fortunate in their qual- 



70 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



ity. The residency is a three and one- 
half year program in which the men 
spend their first year at The Children's 



Hospital Medical Center, the second 
year at the Massachusetts General Hos- 
pital, the first six months of their third 



Charles F. Heinig 


Chief Resident 


7/lAo - 


3/31/61 


John J. Monahan 


Assistant Resident 


7/l/<50 - 


6/3 0/61 




Resident 


7/1/62 - 


12/31/62 


James G. Manson 


Assistant Resident 


7/1/60 - 


6/3 0/61 




Resident 


7/1/62 - 


12/31/62 


David Glazer 


Resident 


/7/1/60 - 


9/30/60 






17/1/61 - 


3/31/62 


James P. Zettas 


Junior Resident 


7/1 /60 - 


3/3 1/61 




Chief Resident 


4/1/61 - 


9/30/61 


Edwin J. Madden 


Junior Resident 


7/1/60 - 


12/3 1/60 


Richard Senghas 


Junior Resident 


7/1 /60 - 


12/3 1/60 


Seymour Zimblcr 


Assistant Resident 








(in Orthopedic Lab.) 


7/1/60 - 


12/31/60 




Assistant Resident 


1/1/61 - 


12/31/61 


Arthur Pappas 


Assistant Resident 








(in Orthopedic Lab.) 


7/1 /60 - 


12/31/60 




Assistant Resident 


4/1/61 - 


3/31/62 




Assistant Resident 


7/1 /61 - 


6/30/62 


Hugh P. Chandler 


Assistant Resident 


10/1/60 - 


9/30/61 


Gordon F. Lupien 


Assistant Resident 


10/1/60 - 


9/30/61 


James Eldredge 


Junior Resident 


10/1/60 - 


3/3 1/61 




Chief Resident 


10/1/61 - 


6/30/62 


William E. Wilson 


Junior Resident 


10/1/60 - 


3/31/61 


Khalil Germanos 


Assistant Resident 


l/l /61 - 


12/31/61 


John B. McGinty 


Junior Resident 


1/1/61 - 


6/30/61 


Lawrence Leonard 


Junior Resident 


1/1/61 - 


6/30/61 


Bernard David Grant 


Junior Resident 


4/1/61 - 


9/30/61 






(also 4/1 /60 - 


9/30/60 


Marvin Weinfeld 


Resident 


4/1/61 - 


9/30/61 


Walid Mnaymneh 


Resident 


4/1/61 - 


9/30/61 


William G. Stewart, Jr. 


Assistant Resident 


5/1 6/61 - 


3/31/62 


Richard Eaton 


Resident 


7/1/61 - 


12/31/61 




Chief Resident 


7/1/62 - 


12/31/62 


Dudley Baker 


Resident 


7/1/61 - 


12/31/61 


Edgar B. Thompson, III 


Assistant Resident 


7/1/61 - 


6/3 0/62 


William C Bostic, III 


Assistant Resident 


7/1/61 - 


6/3 0/62 


Gerald Kenner 


Resident 


10/1/61 - 


3/31/62 


David C Mitchell 


Resident 


10/1/61 - 


3/31/62 


Richard E. Conway 


Assistant Resident 


10/1/61 - 


9/30/62 


Lynn L. Ault 


Assistant Resident 


10/1/61 - 


9/30/62 


Felix A. Battat 


Resident 


1/1/62 - 


6/3 0/62 


Clement Sledge 


Resident 


1/1/62 - 


6/30/62 


Stuart H. Harris, Jr. 


Assistant Resident 


1/1/62 - 


12/31/62 


Robert J. Boyd 


Assistant Resident 


1/1/62 - 


12/31/62 


Christopher Iscnsee 


Resident 


Jl/1/62 - 


9/30/62 






\4/l/63 - 


6/30/63 


Henry D. Wilde, Jr. 


Resident 


4/1/62 - 


9/30/62 


Maureen Molloy 


Resident 


4/1/62 - 


9/30/62 


Robert A. First 


Assistant Resident 


4/1/62 - 


3/31/62 


Arnold Kisch 


Assistant Resident 


4/1/62 - 


3/31/62 


Robert C. Runyon 


Assistant Resident 


7/1/62 - 


6/3 0/63 


Kirby L. C. vonKcssler 


Assistant Resident 


7/1/62 - 


6/30/63 



year at Children's, and in the last year 
one-half of the men finish in rotation at 
the Peter Bent Brigham, and end up 
either as Chief Resident here at Chil- 
dren's or at the West Roxbury Veter- 
ans Hospital. The other half finish 
their residency under the auspices of 
the Massachusetts General Hospital. 
The Residents during this period are 
listed on this page. 

Staff 

I am convinced that our Staff of ortho- 
pedic surgeons works just a little 
harder than any group should. I pay 
tribute to their conscientious industry, 
their excellent care of patients, and 
their contributions to orthopedic sur- 
gery in general. 

The members of our orthopedic 
Staff are responsible not only for the 
care of patients and for teaching and 
research here but also for the teaching 
of orthopedic surgery at the Peter 
Bent Brigham Hospital, and for the 
conduct of the clinical services there 
and at the West Roxbury Veterans 
Hospital — all of which results in a 
very busy interwoven closely knit 
schedule of activities. 

The Staff of a teaching hospital 
such as ours has many duties and 
responsibilities which on the surface 
do not immediately seem to be a part 
of hospital activities but which in 
reality reflect directly upon their re- 
sponsibilities. For one thing, they 
must represent the hospital in local 
medical circles and in meeting places 
in the surrounding New England area, 
and they must represent the hospital 
and the medical school at national and 
international levels. Some of these lo- 
cal activities may be illustrated: for 
example, Dr. Arthur W. Trott dis- 
cussed "Painful Joints in Children" at 
the Noble Community Hospital in 
Westfield, Massachusetts, in January of 
1962, as a part of the Postgraduate 
Assembly of the Massachusetts Medical 



71 



ORTHOPEDIC SURGEON-IN-CHIEF 



Society. He served on the Medical Ad- 
visory Committee of the Norfolk 
County Chapter of the National Foun- 
dation. Dr. Henry H. Banks discussed 
"Fractures of the Neck of the Femur 
of the Aged" at the New England 
Postgraduate Assembly here in Boston 
in November 1961. Dr. Paul P. Grif- 
fin spoke to the Staff of the Roger 
Williams Hospital in Providence, 
Rhode Island, on "Scoliosis" in Novem- 
ber of 1961. Dr. Mihran O. Tachdjian 
discussed "Fractures of the Neck of the 
Femur in Children" at the April 1962 
meeting of the State Trauma Commit- 
tee of the American College of Sur- 
geons here in Boston at the Hotel Stat- 
ler. The orthopedic surgeons of the 
Staff entertained the Russell Hibbs 
Society, made up of orthopedic surgeons 
from all over the United States, here 
in the Jimmy Fund Amphitheater 
April 12, 1962, with a succession of 
papers and demonstrations. I presented 
a clinic in pediatric orthopedics at the 
Augusta General Hospital, Augusta, 
Maine, August 4, 1961. These repre- 
sent a sampling of the types of activi- 
ties which are in frequent demand. 

On the national level, many of 
the members of our Staff served on 
important committees. Dr. Banks is 
now Chairman of the Committee of the 
American Academy for Cerebral Palsy 
on Evaluation of Treatment in Cere- 
bral Palsy, and is a member of the 
Committee on Scientific Exhibits of the 
American Academy of Orthopaedic 
Surgeons. Dr. Jonathan Cohen serves 
on several committees of the American 
Academy of Orthopaedic Surgeons, in- 
cluding the Committee on Biomechan- 
ics and Implants; the Committee on 
Scientific Investigation, of which he is 
Chairman; the Committee on Pathol- 
ogy; and the Committee on Graduate 
Education. He is Assistant Editor of 
the Journal of Bone and Joint Surgery 
and President-Elect of the Orthopaedic 



Research Society. I was Chairman of 
the Committee on Graduate Education 
of the American Academy of Ortho- 
paedic Surgeons, am a member of the 
Advisory Council for Orthopaedic Sur- 
gery and Governor of the American 
College of Surgeons, a member of the 
Committee on the Handicapped Child 
of the American Academy of Pedi- 
atrics, a member of the Clinical Ad- 
visory Committee of United Cerebral 
Palsy, Chairman of the Nominating 
Committee of the American Academy 
of Orthopaedic Surgeons for January 
1962, a member of the Advisory Com- 
mittee of the Office of Vocational 
Rehabilitation, and Consultant to the 
Crippled Children's Program of Massa- 
chusetts. 

Many of our Staff presented pa- 
pers, gave instructional courses, and 
otherwise participated in national 
programs. Dr. Griffin, along with Dr. 
Tachdjian, presented a scientific ex- 
hibit at the American Academy of 
Orthopaedic Surgeons meeting in Janu- 
ary 1962 on "Pauci-articular Arthritis 
in Children," and read a paper on the 
same subject at the meeting of the 
American Medical Association in June 
1962. Dr. Tachdjian was co-author of 
a motion picture presentation and 
movie on cerebral palsy at the meeting 
of the American Academy for Cerebral 
Palsy in St. Louis in October 1961, and 
read a paper on "Intermetacarpal Bone 
Block for Thenar Paralysis" at the 
meeting of the American Orthopaedic 
Association in May 1962. Dr. Banks 
has read papers at the last two meet- 
ings of the American Academy of Or- 
thopaedic Surgeons and of the Ameri- 
can Academy for Cerebral Palsy, as 
have I. I gave Instructional Courses at 
the 1961 and 1962 meetings of the 
American Academy of Orthopaedic 
Surgeons, along with Miss Margaret 
Anderson, and participated in a Sym- 
posium on "Congenital Dislocation of 



the Hip in Childhood." I was the 
invited guest of the Georgia Ortho- 
paedic Society at their annual meeting 
in Sea Island, Georgia, presenting a 
paper on "The Hip in Childhood and 
Some of Its Problems," was a Visiting 
Professor of Orthopedic Surgery at the 
University of Miami School of Medi- 
cine from March 5 to 9, 1962, 
giving the Arthur Weiland Lecture, 
and was the first Samuel Higby Camp 
Visiting Professor of Orthopedic Sur- 
gery at the University of Illinois, April 
9 to 14, 1962. 

These are listed to illustrate the 
breadth of activities which make up 
the daily lives of our Staff and reflect 
upon the reputation and standing of 
our Hospital. All of these activities 
contribute to the face of the Ortho- 
pedic Service of The Children's Hospi- 
tal Medical Center. 

Research 

Research in our Department is in an 
expanding phase. The interests are 
reflected in part by the papers from the 
Department. Dr. Jonathan Cohen has 
been studying the many facets of the 
problems of the reactions of the body 
to metals and of the reaction of metals 
to implants in the human body. With 
the increasing use of prostheses and of 
metals introduced within the body, the 
value of these investigations becomes 
more and more impressive. Other 
areas of Dr. Cohen's interest have in- 
cluded the performance of bone when 
it is implanted in grafts and of the 
effects of radiation on bone and on its 
growth. Dr. Arthur Pappas is asso- 
ciated in these latter studies. Dr. Banks 
has been involved with the comprehen- 
sive study of the hip in the adult and, 
in particular, with the factors con- 
tributing to non-union and aseptic 
necrosis of the head of the femur after 
fracture. He has been concerned with 
the healing of bone and the factors 
influencing it, including nutritional 



72 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



and metabolic factors. Dr. Banks is 
also participating, along with Dr. 
Tachdjian and me, in a study of the 
effectiveness of various surgical meas- 
ures in cerebral palsy. Dr. Griffin has 
had particular interests during this 
period in the study of pauci-articular 
arthritis in children, septic joints in 
the child, and bone tumors. Dr. Tach- 
djian, along with Dr. Banks and other 
associates, has been concerned with de- 
veloping an objective method of re- 
cording motor performance in cerebral 
palsy. His other activities include 
a study of fractures of the neck of the 
femur in the child, and the orthopedic 
manifestations of spinal cord tumors. 
Dr. Tachdjian assisted me in writing 
the orthopedic section of a textbook 
on surgery soon to be published. Dr. 
Trott continued his interest in the cir- 
culation of the extremities as related 
to growth in paralytic disease, in the 
rehabilitation of severely paralyzed pa- 
tients, including respiratory paralysis, 
and in the treatment of paralytic valgus 
feet. He includes in his interests the 
relation of progressive scoliosis to in- 
creasing pulmonary deficit. 

The Growth Study is a particular 
interest of mine where I am ably as- 
sisted by Research Associate Margaret 
Anderson and Research Assistant 
Marie Blais Messner. Particular areas 
of activity during this period include 
analytical studies of the growth of 
bone in children and the growth 
modified by surgery, further refine- 
ments of the tables of prediction of 
growth, study of the effects of trauma 
to the epiphysis on growth, a longi- 
tudinal study of the stimulation of 
growth arising from fractures of the 
shafts of long bones in the lower ex- 
tremities, and a study of the abnormal- 
ities of growth which produce 
deformity of the hip and upper end of 
the femur. The Growth Study repre- 
sents a major activity not only in 



research but in the care of patients as 
well. In 1961, for example, 1,351 pa- 
tients were observed in a study repre- 
senting 2,072 visits for study and 
evaluation. I have been concerned with 
developing and evaluating various sur- 
gical procedures concerned with the 
rehabilitation of the crippled child. 

We are indebted to numerous 
sources for the support of these re- 
searches, in addition to those individuals 
who have contributed so generously to 
the support of our Department. The 
Growth Study is supported in part by 
a U. S. Public Health Grant and by 
Noemi U.O.T.S. The work of Dr. 
Cohen is supported in large part by a 
U. S. Public Health Grant and by the 
Orthopedic Research and Education 
Foundation. The work in cerebral 
palsy is aided by the United Cerebral 
Palsy Foundation, and Dr. Banks' work 
affecting the hip has been aided by a 
U. S. Public Health Grant and more 
recently by the Orthopedic Research 
and Education Foundation, and by the 
National Society for Crippled Chil- 
dren and Adults. The activities of the 
Respiratory and Rehabilitation Unit 
have been assisted by the National 
Foundation. I would like to acknowl- 
edge the generosity of the Chil- 
dren's Cancer Research Foundation 
and Dr. Sidney Farber in providing 
orthopedic research space in the Jimmy 
Fund Building. 

The Peabody Professorship 

In our last Annual Report the need for 
an endowed chair of Orthopedic Sur- 
gery at The Children's Hospital Medi- 
cal Center was emphasized. It is now 
becoming a reality. The Trustees of 
the New England Peabody Home have 
made a gift of $1,000,000 to Harvard 
University to establish 'The Harriet 
M. Peabody Fund" to be used "to ad- 
vance the care and treatment of chil- 
dren, to seek the cause of crippling 
disease, and to spread the benefits of its 



discoveries through the teaching and 
research programs of Harvard Medical 
School." This gift made possible the 
establishment of the Harriet M. Pea- 
body Professorship. In addition, the 
Peabody Trustees voted that other 
funds be given to The Children's Hos- 
pital to permit Children's to establish 
the Peabody Clinic for Crippled Chil- 
dren. In discussing this Professorship, 
Dr. George P. Berry, Dean of the 
Faculty of Medicine of Harvard, stated 
that "this appointment will bring into 
being for the first time a full-time 
Department of Orthopedics at Harvard 
Medical School and The Children's 
Hospital. Together with the establish- 
ment of the Peabody Clinic, there will 
be provided a focal point for the con- 
tinuous interest and support of the 
dedicated Trustees and friends of the 
Peabody Home." It has been my good 
fortune to be appointed as the first in- 
cumbent of this Chair, effective July 
1, 1962. 

The establishment of this Chair 
should, over the years, add great 
strength to The Children's Hospital 
Medical Center and to orthopedic sur- 
gery. The Peabody Trustees have 
chosen this way to carry on their work 
and interest in the solution of the prob- 
lems of the crippled child. The Board 
of the Peabody Home for Crippled 
Children continues its activities and, 
according to Mr. Thorwald S. Paulsen, 
it "will, from time to time, make grants 
for the care and improvement of crip- 
pled children." We wish to acknowl- 
edge our gratefulness to the Board of 
Trustees of the Peabody Home for this 
magnificent benefaction to the Hospi- 
tal, the Medical School, and the De- 
partment of Orthopedic Surgery. 

The Mary MacArthur 
Memorial Respiratory Unit 

The Mary MacArthur Memorial Re- 
spiratory Unit, in addition to serv- 
ing as the headquarters of patients who 



73 



ORTHOPEDIC SURGEON-IN-CHIEF 



have come in with respiratory paralysis 
and as a rehabilitation unit for severe 
paralytic diseases, acts as the center of 
a home care program for patients with 
respiratory poliomyelitis. This in- 
volves, among other activities, the 
checking and repairing of the respira- 
tor equipment of 132 patients scattered 
throughout New England. The actual 
number of respirator patients has 
greatly decreased but patients in the 
respirator form a small proportion of 
those hospitalized in the area. The 
Unit is gradually being converted into 
a rehabilitation unit for severely crip- 
pled children. 

Plans for the Future 

Our orthopedic wards in the Farley 
Building please us more and more as 
time goes on. Arrangements by which 
the units are graduated by age; the 
emphasis on multiple bed units with 
larger sized units for the young and on 
four-bed and two-bed accommodations 
for older children, with some single 
units; provision of adequate space in 
each unit to permit effective teaching 
rounds and the easy handling of ortho- 
pedic beds and orthopedic cases — all 
of these contribute to an effective unit. 
In contrast to this is the fact that our 
facilities for out-patient services are 
poorly arranged, unattractive, and 
crowded and present a poor introduc- 
tion for patients to our Hospital. We 
emphasized in our last report that the 
out-patient clinic is where a hospital 
meets a large part of its public and is 
the site of first contact of the patient 
with the hospital. 

Ambulatory services are becoming 
a larger and larger part of Hospital 
activities. To meet these demands a 
new ambulatory clinic seems most im- 
portant if the Hospital is to move 
ahead. The plans of such a facility 
should consider not only the current 
techniques of delivering medical serv- 
ices but should be such as to be adapt- 



able to changing patterns of delivering 
medical care as they evolve. In plan- 
ning an orthopedic and rehabilitation 
unit, it must be adequate in size, closely 
related to physical therapy and other 
services related to rehabilitation, should 
provide for orthopedic Staff offices re- 
lated to the out-patient and examining 
areas, should be in close proximity to 
the Radiology Department, and should 
have a vocational evaluation, guidance, 
and testing area which is available to 
the out-patient, to house patients, and 
to day patients. 

Research space is another imme- 
diate need of our Department. A 
major part of our research area is 
borrowed space from the Children's 
Cancer Research Foundation. The es- 
tablishment by the Harvard Medical 
School of the Peabody Professorship 
and its related support emphasizes the 
importance of our needs in this area. 
Further basic support will be provided 
by the Frank R. Ober Research Fund 
and other funds which have come to 
the Department. Research must play 
an expanding part in our plans and 
activities. 

The plan for a clinic and re- 
search building located between Build- 
ing A and the Farley Building has 
much appeal. It would appear to be 
the most effective arrangement to 
provide comprehensive care for the 
child. It would provide close physical 
relation of the out-patient and clinical 
research area with the existing in- 
patient unit and would permit the effi- 
cient location and distribution of serv- 
ices for both units. It would present a 
new face for the entrance of patients 
to the Hospital, which should add im- 
measurably to our strength. 

Our Department envisages an ex- 
panding Staff. "We are in a position of 
change which cannot be made sud- 
denly. In expanding the Staff it must 
be recognized that the future of ortho- 



pedic surgery here at Children's de- 
pends upon "specialists" in particular 
areas of pediatric orthopedic surgery 
contributing to the field, developing 
new methods, and providing services 
which are not generally available. It 
must be prepared to give superior 
clinical care and consultation services 
in all areas of clinical orthopedics and 
rehabilitation. 

I wish finally to thank all those 
who have made gifts to the Depart- 
ment during these two years, to express 
my admiration and appreciation for 
the efforts of the Orthopedic Staff, the 
Residents, Nursing, Physical Therapy, 
the secretaries of the Department, and 
my thanks for the support of the 
Trustees and Administration in all of 
its ramifications. 

William T. Green, M.D. 
Orthopedic Surgeon-in-Cbief 



74 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Publications 

Banks, H. H., Factors influencing the 
result in fractures of the femoral 
neck. /. Bone & Joint Surg., 44A: 
931-964, 1962. 

Banks, H. H., and Green, W. T., Ad- 
ductor myotomy and obturator neu- 
rectomy for correction of adduction 
contracture of hip in cerebral palsy. 
/. Bone & Joint Surg., 42/4:111-126, 
I960. Abstracted, Year Book of 
Orthopedics and Traumatic Surgery, 
1960-1961 Series, Year Book Medi- 
cal Publishers, Chicago, 1961. 

Chazen, E., Cook, C. D., and Cohen, J., 
Focal scleroderma. Report of 19 
cases in children. /. Pediatrics, 60: 
385-393, 1962. 

Cohen, J., Tissue reaction to metals — 
the influence of surface finish. /. 
Bone & Joint Surg., 43/4:687, 1961. 

, Metallic failure in devices 

implanted in the body. Surgical 
Clinics of North America, 41:1645- 
1653, 1961. 

-, Corrosion testing of orthope- 



dic implants /. Bone & Joint Surg., 
44/4:307-316, 1962. 

Cohen, J., and D'Angio, G., Unusual 
bone tumors after roentgen therapy 
of children. Two case reports. Am. 
J. Roentgenology, 86/502-5 12, 1961. 

Cohen, J., and Foultz, W. S., Failure by 
corrosion of a Steinmann pin used 
for intramedullary fixation. /. Bone 
& Joint Surg., 42/4:1201-1206, I960. 

Cohen, J., and Maletskos, C. J., Ca 45 
in the study of bone grafts in dogs. 
Proceedings CIOMS Symposium on 
Radioisotopes and Bone (August 
29-September 3, I960), Princeton, 
N. J., pp. 127-148. 

Cohen, J., and Sledge, C. B., Diastem- 
atomyelia. An embryological inter- 
pretation with report of a case. Am. 
J. Diseases of Children, 100:263, 
1960. 

Compere, E. L., and Tachdjian, M. O., 
Orthopedic Section, Lawyer's Medi- 



cal Cyclopedia. Personal Injuries and 
Allied Specialties. VoL VI, Sect. 39. 
1-45.13, pp. 99-165, Allan Smith 
Co., Indianapolis, 1961. 
Green, W. T., Chairman, Committee 
on Undergraduate Teaching, Com- 
mittee on Education, Am. Acad. 
Ortho. Surgeons, Undergraduate 
teaching in orthopedic surgery. /. 
Bone & Joint Surg., 43/4:453-460, 
1961. 
Green, W. T, Objectives of a depart- 
ment of orthopedics in a medical 
center. /. Bone & Joint Surg., 43 A: 
782-784, 1961. 
Green, W. T, and Anderson, M., Skel- 
etal age and the control of bone 
growth. Am. Acad. Ortho. Surgeons, 
Instructional Course Lectures. C. V. 
Mosby Co., St. Louis, Vol. XVII: 
199-217, I960. 
Green, W. T, and Banks, H. H., The 
flexor carpi ulnaris transplant and 
its use in cerebral palsy. /. Bone & 
Joint Surg., 44/4:1343-1352, 1962. 
Hilding, D. A., and Tachdjian, M. O., 
Dysphagia and hypertrophic spurring 
of the cervical spine. N. E. J. Med., 
263:11-14, I960. 
Quigley, T. B., and Banks, H. H., Medi- 
cal progress, treatment of fractures 
and dislocations, 1950-1960. N. E. 
J. Med., 236:344-349, 391-397, 444- 
452, 493-501, I960. 
Tachdjian, M. O., Davis, P. H., and 
Conklin, C, Ununited fractures of 
the carpal navicular — treatment by 
combined bone-grafting, internal 
fixation with vitallium lag screw, 
and radial styloidectomy. Proceed- 
ings, /. Bone & Joint Surg., 42A: 
905, 1960. 



75 



CHAIRMAN, DIVISION OF LABORATORIES AND RESEARCH 



REPORT OF CHAIRMAN, 
DIVISION OF LABORATORIES 
AND RESEARCH 

^TMBnra^^TTT^nrigi muiwiMHBiimMmm iiii 

This Division consists of the Depart- 
ment of Pathology, the Laboratories of 
Clinical Pathology, and the Research 
Division of Infectious Disease. It is 
closely allied by historical development 
and common Chairmanship with the 
Children's Cancer Research Founda- 
tion, and acts as a connecting link 
between The Children's Hospital 
Medical Center and the Foundation. 
This report will present recent facts 
and accomplishments of the several 
parts of the Division of Laboratories 
and Research, placed in historical set- 
ting. Justification for a brief backward 
look is found in the fact that more 
than thirty-five years have elapsed since 
I first joined the Staff of The Children's 
Hospital. It was August, 1927, when I 
was appointed by Dr. S. Burt Wolbach 
to develop a Department of Pathology 
at The Children's Hospital. In addi- 
tion to this professional association, I 
have had the opportunity from 1931 
to the present, first as Secretary to the 
Staff Executive and Planning Com- 
mittees, and then as Chairman of the 
Committee for the Planning of The 
Children's Medical Center, to partici- 
pate in the creation of plans for the 
expansion of The Children's Hospital, 
first into a complete general hospital 
for children and then, in 1946, to a 
medical center for children. This has 
been a voluntary assignment with no 
administrative duties. This preoccupa- 
tion with the plans for the develop- 
ment of The Children's Medical Center 
and the related activities in medical 
planning on the national and inter- 
national scene, in both voluntary and 
governmental agencies, have consti- 
tuted through these years an avocation 
which has brought a measure of deep 
satisfaction, as well as frustration, 
fulfillment of many dreams, and, above 
all, an ever increasing opportunity to 
make an added contribution to the 
fields with which my professional life 
has been concerned: teaching, the care 



of the patient, and the cure and pre- 
vention of disease through research. 
Under the wise and courageous leader- 
ship of the late President of the Board 
of Trustees, J. Wells Farley, the plans 
of the Staff, fashioned during the 
decade before World War II, were 
translated into actual accomplishments 
by the enthusiastic labors of a large 
number of lay and professional people 
who were devoted to The Children's 
Hospital. Dreams must precede plans, 
and actual accomplishments should 
precede dreams, if there is to be a solid 
foundation for new structures. Dreams 
usually out-distance the fulfillment of 
plans, and so we find under contempla- 
tion today, on drawing boards, fash- 
ioned by Committees of our President, 
Mr. Wolbach, and the new General 
Director, Dr. Cronkhite, sketches and 
blueprints giving promise of life to 
ideas conceived many years before and 
stored against the day when fiscal con- 
siderations would permit their trans- 
lation into reality. To the President 
and Trustees and to the new General 
Director go the greetings and good 
wishes of the members of the Staff 
of this Division and their confidence 
that solutions will be found for the 
problems of economic nature which 
have troubled hospitals everywhere. 

A Department of Pathology of 
The Children's Hospital was mentioned 
officially for the first time in 1879, ten 
years after the opening of the Hospital, 
but it had no recognizable form within 
the Hospital for many years. Dr. Wol- 
bach gave his services from the Har- 
vard Medical School from 1915 until 
1924, when a small laboratory was 
organized in the basement below the 
old operating room to house a Resi- 
dent and technician. Dr. Wolbach's 
invaluable contributions to The Chil- 
dren's Hospital continued until his 
death in 1954. 

One of the first steps in the 
expansion of the Hospital into The 



76 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Children's Medical Center was the 
approval by the Board of Trustees of 
our plan for a Division of Laboratories 
and Research which was officially in- 
augurated July 1, 1946. The first unit 
to be included in this new division was 
the Pathology Department. This had 
been organized in 1927 on the premise 
that its primary responsibility was to 
conduct routine studies in post mortem 
and surgical pathology of a caliber 
usually associated with special research 
endeavors. Several hundred bound vol- 
umes of post mortem and surgical 
studies carried out in scholarly fashion 
record the observations of the few 
hundred men-in-training and their 
mentors in a manner so detailed and 
accurate that they have served as the 
basis and inspiration for large numbers 
of publications from the many Divi- 
sions of the Hospital since 1927. We 
are proud that they have served, too, 
as the background and as part of the 
substance of textbooks and mono- 
graphs written by members of the 
several clinical divisions of the Hos- 
pital. 

With its routine responsibilities 
carried out on such a high plane, the 
Department was able to devote, at the 
same time, energy to the education of 
pathologists and of clinicians who 
spent periods of training from six 
months to two years in the laboratory 
of pathology or in the performance of 
their own research in experimental 
pathology. The first four years of my 
service in the Department were spent 
in the basement below the operating 
rooms of the old Hospital, in quarters 
painfully inadequate for the task. 
Much finer quarters were provided in 
1931 and this is where the Department 
is housed at present. The space, ex- 
pertly designed for the purpose in 
1931, has been outgrown for many 
years. 

The character of the Department 



in its early years is illustrated best by 
the fact that as many as eighteen sepa- 
rate research programs were carried 
out at one time on a part-time basis 
by members of other Departments in 
the Hospital in collaboration with the 
Staff of the Department of Pathology. 
Of particular interest was the first of 
these in 1927. This was a project of 
importance to Dr. Robert Osgood and 
Dr. Frank R. Ober, carried out by Dr. 
Calvin Page with my aid, and had to 
do with the control of osteomyelitis by 
maggots. This marked the beginning 
of an active twenty-year collaboration 
between Dr. Ober and myself in the 
creation of plans for the development 
of orthopedic research, culminating in 
the establishment of the Frank R. 
Ober Fund for Orthopedic Research 
and arrangements for the eventual 
strengthening of this fund from Dr. 
Ober's own estate. 

Through these years we have had 
the privilege of working intimately in 
the development of the Department of 
Orthopedic Surgery, sharing our space 
and equipment in much of its experi- 
mental activities. From 1930, when 
Dr. Ober brought Dr. William T. 
Green to The Children's Hospital, 
most of this collaboration has been 
with Dr. Green or in association with 
him and a whole series of orthopedic 
Residents who spent part of their time 
in the Department of Pathology. 

The great need for an expanded 
research program in orthopedic surgery 
and the promise of developments in 
this field as demonstrated by Dr. 
Green and his colleagues weighed 
heavily in the decision of the Staff 
Planning Committee and the Staff 
Executive Committee to recommend 
to the Trustees of The Children's 
Hospital, and to the Trustees of the 
New England Peabody Home, that 
our Department of Orthopedic Surgery 
be chosen as the recipient of funds 



from the New England Peabody Home. 
With this support, Harvard Medical 
School under Dean George P. Berry, 
in agreement with our Trustees under 
Mr. Wolbach, established the first full 
professorship of orthopedic surgery in 
our history. Dr. Green became, in 
July 1962, the first Harriet M Pea- 
body Professor of Orthopedic Surgery 
at The Children's Hospital. It was 
particularly pleasant to participate in 
these happy decisions after thirty- 
five years of deep personal interest in 
and association with the development 
of orthopedic research in this Hospital. 
We are looking ahead to the rapid 
growth of these activities during the 
next few years under Dr. Green and 
his colleagues. 

The role of the Department of 
Pathology is well illustrated in the 
solid foundation of careful anatomical 
studies on congenital heart disease 
which gave to the brilliant surgery of 
Dr. Robert E. Gross the necessary 
foundation on which to base diagnosis 
and create new surgical attacks on 
previously incurable heart disease. This 
was before the day of such modern 
diagnostic methods as those used so 
effectively by Dr. Alexander Nadas. 
The wealth of post mortem observa- 
tions thus constituted a background 
for both surgical and medical aspects 
of congenital heart disease in children, 
and served as a fitting jumping-off 
point for the extraordinary develop- 
ments by others in diagnosis, treat- 
ment, and now prevention of con- 
genital malformations. 

A similar contribution of basic 
information completely essential for 
further clinical and physiological 
studies was made in the studies on the 
pathology of the newborn and the 
premature infant. Direct application 
of what was learned in the post 
mortem room resulted in the saving of 
large numbers of both premature and 



77 



CHAIRMAN, DIVISION OF LABORATORIES AND RESEARCH 



full term babies. The important con- 
tributions to our knowledge of the 
newborn by Dr. Clement Smith and 
his colleagues grew out of these initial 
studies and collaborative investigations, 
which they then developed into a 
major field of pathologic physiology of 
its own, here and more so at the 
Boston Lying-in Hospital, in what has 
become a renowned laboratory of 
newborn physiology and clinical in- 
vestigatioa 

Similar contributions could be 
mentioned to the clinical disciplines of 
neurosurgery, endocrinology, radiology 
and radiotherapy, renal and metabolic 
disease, hematology, and many other 
fields of activity represented today in 
The Children's Hospital Medical 
Center. This is the function of any 
good Department of Pathology which 
recognizes that although it has com- 
plete freedom to carry out its own 
research without restriction as to sub- 
ject matter, techniques employed, or 
kinds of collaboration, it should act 
also as assistant and consultant, both in 
routine and investigative problems, to 
other members of the Hospital Staff. 
Because of its unique position in the 
Hospital community, it has a magnifi- 
cent opportunity to play an important 
role in the teaching of medical stu- 
dents, Interns, Residents, and older 
doctors as part of their continuing 
education. And this it has done in an 
enthusiastic and effective manner 
through these years. 

Inevitably growing out of such a 
conception is the crossing of lines of 
disciplines and departments in behalf 
of the patient or in the solution of 
problems of basic or applied research. 
This can and should be done without 
interference to the growth of individ- 
uals or departments. The team con- 
cept has been developed to a high 
point during the last fifteen years, but 
was recognizable in our daily work 
before 1930. The Division of Labora- 



tories and Research was therefore a 
logical development. We described it 
originally in terms of the utilization 
of the techniques of biology, chemistry, 
and physics applied to the various 
laboratory disciplines basic to medi- 
cine, surgery, and pathology for the 
solution of mental and physical prob- 
lems concerned with the normal and 
the sick infant, child, and adolescent. 
This original description called for 
the provision of expert professional 
assistance by the members in this 
new Division to the research programs 
originated in and conducted by the 
several clinical departments of the 
Hospital. 

One part of this plan called for 
the grouping together of all of the 
routine clinical laboratories then scat- 
tered throughout the Hospital into 
one department of clinical laboratories, 
headed by a man of competence with 
his professional associates who could 
give supervision of a caliber not pos- 
sible before. Since its inception in 
1946 the Laboratories of Clinical Path- 
ology have been under the supervision 
of Dr. Harry Shwachman, who has 
contributed to the high level of care of 
our patients, in addition to adding to 
an important degree to the Hospital 
income. Because of circumstances that 
will not be discussed further here, the 
full plan for the Division of Labora- 
tories and Research was not carried 
out. In small part this is explained by 
the pattern of the development of re- 
search in the several clinical depart- 
ments. But far more important, the 
time was not yet ripe for the creation 
of proper facilities and the provision 
of appropriate support by the Hos- 
pital. The need for research space is 
indeed today still a pressing need 
equaled only by that for space for 
ambulatory and administrative services. 

Three new research departments 
of the Division of Laboratories and 
Research were added in 1947 and one 



of these remains. The first was a 
Laboratory of Biochemistry, under a 
professional biochemist. This lasted 
but a short time. This deficiency was 
replaced by a far greater development 
in chemistry in the Children's Cancer 
Research Foundation. The second, the 
Division of Nutritional Research, was 
created for Dr. S. Burt Wolbach on 
his retirement from the Shattuck Pro- 
fessorship at Harvard Medical School 
in 1948, to permit him to continue his 
epoch-making contributions ro our 
knowledge of vitamin deficiency states. 
This Division continued until Dr. 
Wolbach's death in 1954. The third, 
the Research Division of Infectious 
Disease, with Dr. John F. Enders as 
the first Chief in 1947, has had a 
brilliant history. Dr. Enders is still its 
Chief, although his Harvard appoint- 
ment was altered when he became a 
University Professor. He retains his 
quarters in the old Carnegie Building 
and has also occupied the much larger 
space in the Jimmy Fund Building of 
the Children's Cancer Research Foun- 
dation since it was dedicated in Janu- 
ary, 1952. In the Foundation, Dr. 
Enders holds the title of Chief of the 
Virus Research Laboratories and in 
this capacity investigates the relation- 
ship of viruses to cancer. 

All of the other basic science 
divisions conceived in the original plan 
when the Division of Laboratories and 
Research was created as a first step 
toward the building of an Institute of 
Pediatric Research, have developed in 
the Children's Cancer Research Foun- 
dation which was founded in 1948 as 
an affiliate of The Children's Hospital 
Medical Center. The members of the 
staff of the Foundation hold appoint- 
ments for the most part in the De- 
partment of Pathology or in appropri- 
ate clinical departments in the 
Hospital. 

The clinical and laboratory re- 
search activities of the Children's 



78 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Cancer Research Foundation will not 
be discussed further in this report 
except for a simple listing of areas 
of chief interest. The laboratory divi- 
sions include: biochemistry, enzyme 
chemistry, organic chemistry, bio- 
physics including crystallography, vi- 
rology, tissue culture, genetics, cell 
biology, experimental hematology and 
pathology, tissue ultrastructure, molec- 
ular biology, carcinogenesis, ultraspec- 
trophotometric methodology, pharma- 
cology and pharmacodynamics, cancer 
chemotherapy, tissue and organ trans- 
plantation, and immunology. The larg- 
est single program concerns the search 
for chemical agents for die control of 
cancer; their synthesis, mechanism of 
action, toxicity, pharmacological be- 
havior, and application to the patient 
with disseminated cancer. The publi- 
cations of the Foundation are included 
in the general bibliography of the Di- 
vision of Laboratories and Research. 
The Foundation makes available to the 
Staff of The Children's Hospital Medical 
Center a large number of experts in 
many scientific disciplines. Our tumor 
therapy group, under my immediate 
direction and including representatives 
of the several clinical and laboratory 
divisions of rhe Hospital, is responsible 
for the care and study of the largest 
number of children with acute leu- 
kemia and other forms of disseminated 
cancer gathered in any one institution 
in the world. It collaborates in a very 
effective program with the clinical 
staff of the Hospital in behalf of 
those patients requiring care in The 
Children's Hospital. Here is a splendid 
example of important collaboration by 
two institutions joined together in an 
affiliation but financially independent. 
Two important developments in 
the Harvard Medical School are at- 
tributable to members of the Founda- 
tion staff who have held research titles 
in our Department of Pathology. The 
first former member of the Foundation 



and the Department of Pathology to 
achieve recognition was the late Dr. L. 
Lahut Uzman, who for four years was 
head of the Laboratories of Lipid and 
Protein Chemistry in the Foundation, 
with a research title in the Department 
of Pathology. It was here that he did 
his internationally recognized work on 
the chemical basis of lipoprotein he- 
reditary disorders. To our great pride, 
he was chosen by Harvard to be the 
first Bronson Crothers Professor of 
Child Neurology at The Children's 
Hospital and the medical world looked 
to him for the establishment of a 
truly great department, both clinically 
and in research. This young man of 
tremendous achievement and far 
greater promise, possessed of an intel- 
lect which called forth the respect of 
people in the arts as well as in the 
sciences, was lost to the world less 
than six months after he assumed his 
Professorship. We recall with pride 
that in this environment he was able 
to demonstrate his greatness as a very 
young man, and that to this environ- 
ment he returned to build what would 
have been an enormous contribution to 
child neurology and to science. 

The second, Dr. Elkan R Blout, 
since 1949 Head of the Laboratories of 
Biophysical Chemistry of the Founda- 
tion, was named Professor of Biological 
Chemistry at Harvard Medical School, 
effective January 1, 1963. During his 
tenure as a member of the Foundation 
staff, with a research title in the De- 
partment of Pathology, he and his col- 
leagues contributed to more than sixty 
important publications in a field of 
great importance to our knowledge of 
protein chemistry. This laboratory has 
become world-renowned during the 
past fourteen years, and has brought 
great honor to the entire Children's 
Hospital Medical Center and the 
Harvard Medical School, as well as 
to the Foundation which sponsored, 
housed, and supported him. 



Department of Pathology 

The daily responsibilities of the De- 
partment of Pathology are supervised 
by Dr. Gordon F. Vawter, and by his 
junior and House Staff. The routine 
of the Department has continued to 
be of high caliber. Dr. Vawter's schol- 
arly contributions have enriched all 
parts of the Hospital. He has dem- 
onstrated an unselfishness and a devo- 
tion to excellence which have been 
recognized by the appreciation of his 
own House Staff, and by the older 
members of the staff of the several 
clinical services. His contributions are 
to be found in many clinical papers 
written by others whose work he has 
helped to make possible. The Depart- 
ment participates in a vast teaching 
enterprise not only in the second year, 
but also in the third and fourth years 
as welL In the year ending June 30, 
1962, the Department performed 304 
autopsies and gave diagnostic reports 
on 1,576 surgical specimens, 152 
guinea pigs for tuberculosis, 325 as- 
sorted consultations, and 804 bone 
marrow examinations. Material for 
special study was furnished to many 
members of the Staff and to scientists 
in institutions in several parts of the 
country. In particular, research support 
of special nature was supplied to Drs. 
Schuster, Harkins, Harris, Fellers, and 
Shahidi. Members in training in the 
Department until June 30, 1962 in- 
cluded: Dr. A. Bhaktaviziam, Dr. A. M. 
Alkan, Dr. L. Rev-Kury, Dr. L. Cha- 
meides, Dr. E. T. Hedley Whyte, Dr. 
L. Miranda, Dr. L. Berman, Dr. K. 
Osborn, ©r. Ariga Moussa, Dr. G. 
Smith, Dr. P. M. Ming, and Dr. J. 
Craighead. The Children's Cancer Re- 
search Foundation supports two senior 
members of the Department, Dr. A. 
Bhaktaviziam and Dr. Mei Shea 

Dr. Vawter and his colleagues are 
participating at the moment in twelve 
projects in collaboration with seven 



79 



CHAIRMAN, DIVISION OF LABORATORIES AND RESEARCH 



other groups of investigators. The 
fields of activity vary from nutritional 
and metabolic disease, with particular 
reference to the gastrointestinal tract, 
the kidney, the central nervous system, 
and bone; to studies of the techniques 
and long term follow-up of various 
disturbances and malformations of the 
cardiovascular system. 

Laboratory of Orthopedic 
Pathology 

The program under Dr. Jonathan 
Cohen is part of a collaborative ar- 
rangement begun fifteen years ago with 
the Department of Orthopedic Surgery, 
under Dr. William T. Green. This 
work is conducted in the Children's 
Cancer Research Foundation's Jimmy 
Fund Building. Dr. Cohen and his 
assistants have continued to study tis- 
sue reactions to metal objects, includ- 
ing assay procedures and clinical 
aspects of incompatibility of tissue to 
surgical implants. He has explored 
the basic cellular reaction to small gran- 
ules of metal and the reaction of bone 
to irradiation. Much of this work has 
important practical significance to or- 
thopedic surgery. Recognition of Dr. 
Cohen's contributions is shown by his 
election to the Presidency of the Ortho- 
pedic Research Society and to the 
Pathology Committee of the American 
Association of Orthopedic Surgeons, 
which is concerned with the training 
of Fellows in orthopedic pathology. He 
serves also as a member of the Edi- 
torial Board of the Journal of Bone 
and Joint Surgery. Dr. Cohen's labora- 
tory is one part of the training pro- 
gram of orthopedic Residents. His re- 
search and teaching activities give and 
receive great support from this associa- 
tion with the Department of Pathology. 

Other Special Fields of 
Pathology 

The Department of Pathology has been 
strengthened greatly by the availability 



of three senior pathologists who are 
members of the staff of the Children's 
Cancer Research Foundation and are 
available to the Department of Pathol- 
ogy for consultation and cooperative 
research. 

Dr. Agnes Burt Russfield, a rec- 
ognized authority in the field of en- 
docrine pathology, has made her knowl- 
edge, experience, and research activities 
available to the Department Staff and 
to members of the clinical staff of the 
Hospital, such as Dr. John Crigler, 
whose active clinical and experimental 
program in endocrinology is a part of 
Dr. Charles Janeway's Department. 
Dr. Giuseppe Cardinali, a highly gifted 
hematopathologist and investigator, is 
carrying on collaborative work with 
Dr. Vawter and acts as a consulting 
hematopathologist to the Department. 
Dr. Betty Geren Uzman, who began 
her career in pathology as an Intern in 
our Department of Pathology and who 
since has gained world recognition for 
her contribution to the origin of 
myelin in the peripheral and central 
nervous systems, has been a member of 
the Foundation staff, with a research 
title in the Department of Pathology, 
for fifteen years. The first electron 
microscope in the entire Harvard Med- 
ical-Longwood area was purchased by 
the Foundation for Dr. Geren's re- 
search in 1952. Arrangements have 
been made in the Foundation for train- 
ing in electron microscopy of any 
members of the Hospital Department 
of Pathology or Hospital Staff. 

Laboratory of Brain 
Development 

Dr. J. LeRoy Conel continues his 
fundamental contribution to our knowl- 
edge of the postnatal development of 
the human cerebral cortex, which he 
began in our Department in 1930, by 
arrangement with and the enthusiastic 
cooperation of Dr. Wolbach and my- 



self. Volume 7 of his internationally 
recognized series of monographs on 
this subject will be ready for distribu- 
tion February 28, 1963, and Volume 
8, on the investigation of die cortex of 
the brain of the six-year-old child, 
has been under way for a year. These 
studies have constituted the most val- 
uable basis for the study of develop- 
mental behavior of children. They 
have been supported entirely by a grant 
we obtained originally in 1949 from 
the National Institutes of Health for 
Dr. Conel's work. This has been con- 
tinued through the years and is in 
operation at the present time. 

A recent professional apprecia- 
tion of Dr. Conel's work by Dr. Alfred 
Meyer, Professor Emeritus of Neuro- 
pathology at the University of London, 
gives a magnificent summary of and 
tribute to Dr. Conel's contribution. 
He writes: "he has for the first time 
singularly succeeded in moulding the 
older with his numerous new observa- 
tions into an organic whole. In doing 
so, he has earned the gratitude of all 
(anatomists, physiologists, psycholo- 
gists and paediatric clinicians) who are 
interested in the problem of matura- 
tion." Dr. Meyer continues in his 
paper written in 1961: "the conclud- 
ing pages of the 6th volume, with their 
emphasis on fundamental problems of 
structure and function, seem to portend 
that this may be the last volume of 
the series from the pen of Professor 
Conel." Volume 7 has been finished 
by Dr. Conel, since Dr. Meyer wrote 
those words, and Volume 8 is well 
under way. We are happy to report 
that Dr. Conel has already passed the 
expectation of Dr. Meyer for this 
epoch-making investigation. 

It is our hope that Dr. Conel will 
continue for many years to come and 
that he will join the efforts of the 
Conel Laboratory in the Department 
of Pathology with those which have 



80 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



been inspired by him, particularly 
within the framework of the newly 
conceived International Institute of 
Brain Research. Dr. Theodore Rabin- 
owicz, Neuropathologist in the Uni- 
versity of Lausanne, has visited Dr. 
Conel to plan his own continuation of 
this work in the development of the 
prenatal cerebral cortex. It is a deep 
satisfaction that this internationally 
recognized scholarly contribution arose 
in our Department of Pathology, and 
thrived so magnificently in this en- 
vironment over the last thirty-two years 
to become a classic in the history of 
medicine. We take this opportunity to 
salute Professor Conel and to congrat- 
ulate him on his scholarly achievement 
and dedication to a task few men 
would have dared to undertake. We 
wish him many years of productive 
scholarship in his chosen field and are 
proud that his contributions form such 
a significant background for many 
important recent developments in our 
understanding of mental retardation, 
cerebral palsy, and the rapidly de- 
veloping discipline of neurology of 
early life. 

Laboratory of Neuropathology 

I established this laboratory as a part 
of the Department of Pathology five 
years ago, under the immediate direc- 
tion of Dr. Betty Q. Banker. This has 
been suppored by funds obtained from 
the National Foundation for Neuro- 
muscular Diseases, Inc 

The initial purposes of this labora- 
tory are still: the routine study of 
biopsy and autopsy material of neuro- 
pathological interest; the special study 
of problems encountered in the course 
of the routine study; the establishment 
s>f a teaching center for many to learn 
the basic fundamentals of neuropathol- 
ogy; and the presentation of neuro- 
pathological material to the patholo- 
gists, neurologists, neurosurgeons, and 
pediatricians. 



Under Dr. Banker this depart- 
ment flourished and became a vital part 
of the intellectual activities of the 
entire Medical Center, and received 
recognition at the Harvard Medical 
SchooL In December, 1961 recognition 
of the contribution of this laboratory 
was shown by the award of a training 
grant from the National Institute of 
Neurological Disease and Blindness. 
Unfortunately, Dr. Banker was forced 
to resign July 1, 1962, because her 
husband had accepted a professorship 
in Cleveland. With her go the good 
wishes of the Department and the Hos- 
pital and this acknowledgment of the 
important contribution that she made 
in such a short time to our knowledge 
of neuropathology of early life. 

We were fortunate in securing as 
her successor Dr. Floyd D. Gilles, who 
came to us from Baltimore with a back- 
ground of training in neurology, gen- 
eral pathology, and neuropathology. 
With Dr. Vawter's immediate collabo- 
ration and support, Dr. Gilles has un- 
dertaken his new opportunities with 
vigor and promise and is working ac- 
tively and effectively with the mem- 
bers of the Departments of Pathology, 
Neurology, and Neurosurgery. 

Research Division of 
Infectious Disease 

This section is taken from reports 
written by Dr. John F. Enders, Chief 
of this Division, and covers investiga- 
tions carried out during the calendar 
year 1962, but mentions also further 
extensions or completion of studies 
undertaken earlier. An attached bibli- 
ography of papers published during 
this period can be utilized for detailed 
accounts, since this report will neces- 
sarily comprise only a summary of the 
work described. 

In general, the direction of re- 
search has been toward the elucidation 
of various aspects of viral cytopatho- 



genicity. In addition to more "funda- 
mental" aspects of this significant 
phenomenon, laboratory investigations 
have been carried out on patients with 
viral infections and epidemics of sus- 
pected or demonstrated viral orgin. 

With the exception of research on 
measles vaccine, all other investiga- 
tions have been supported directly by 
the U. S. Public Health Service, U. S. 
Department of Health, Education and 
Welfare, through the National Insti- 
tutes of Health. The measles work has 
been supported mainly by the U. S. 
Army. 

Interferon 

A previous observation indicated that 
an attenuated strain of measles virus 
stimulated the production of more in- 
terferon in infected cell cultures than 
the virulent form from which it was 
derived. Similar data have now been 
obtained with attenuated and virulent 
strains of polio virus and mumps virus. 
It is planned to determine whether this 
difference holds in vitro with other 
agents, such as influenza virus. Con- 
tinuing studies have attempted to 
determine the possible role of in- 
terferon in viral oncogenesis (see 
below) and in the susceptibility of the 
human fetus and infant to overwhelm- 
ing infection with certain viral agents. 
Using a strain of attenuated type II 
polio virus, it has been found that 
with increasing age of the donor from 
whose renal tissues the cells were pre- 
pared, there is an increasing capacity 
of these human kidney cells in vitro 
to elaborate interferon. To date, tis- 
sues have been tested from fetuses, 
newborns, and older infants. 

SV40 Virus and Viral 
Oncogenicity 

Recently it has been demonstrated in 
this laboratory that the simian agent 
SV40, lately found to be a frequent 
contaminant of polio virus vaccines, 



81 



CHAIRMAN, DIVISION OF LABORATORIES AND RESEARCH 



and capable of inducing tumors in 
hamsters, multiplies readily in cultures 
of various kinds of human embryonic 
cells. On passage in human embryonic 
kidney cells from newborns and in- 
fants of three months, the agent in- 
duces characteristic cytopathic effects. 

A reproducible epithelioid trans- 
formation in primary cultures of hu- 
man renal tissue infected with this 
same virus has been observed. This 
transformation is characterized by an 
abnormal growth pattern, a greatly ac- 
celerated growth rate, and chromoso- 
mal aberrations (analyzed by Dr. 
George Yerganian and Rei Kato of 
the Children's Cancer Research Foun- 
dation) of the cells. 

Cell-virus relationships have been 
studied during the course of the cy- 
tolytic, proliferative, and transforming 
changes that occur in this system. In- 
terferon has not been demonstrated in 
the chronically infected cells as com- 
pared to cells in uninfected cultures. 
Transformed cells exhibited increased 
resistance to injury by SV40 and an 
altered cytopathic response to infec- 
tion with several RNA viruses. 

With Dr. Jeana Levinthal of the 
Department of Bacteriology at the 
Harvard Medical School, an indirect 
immunofluorescent technique has been 
shown to be sensitive for the detection 
of SV40 virus in infected human and 
monkey kidney cells. In addition, a 
complement-fixing antibody has been 
shown to be present in the kidney 
cells of rabbits and guinea pigs hyper- 
immunized with the virus. 

Studies are continuing with cloned 
cell lines from the SV40 transforma- 
tion derived both from human tissues 
and embryonic hamster tissues which 
have recently been found similarly sus- 
ceptible. 

A filterable agent has been iso- 
lated from a transplantable spontane- 
ous carcinoma of the Syrian hamster 



associated with an acute hemolytic ane- 
mia. Under investigation are its iden- 
tity as a virus, its behavior in vitro in 
a variety of cell systems, and its poten- 
tial as an inducer of cell transforma- 



Effect of Hormones on Viral 
Multiplication and 
Cytopatbogenicity 

Clinical evidence indicates that altera- 
tion in sex hormonal balance may in- 
fluence the inception and course of 
viral disease (e.g., poliomyelitis in 
pregnancy). Few observations have 
been made on the effect of sex hor- 
mones in cell cultures infected with 
viruses. A study of this sort has re- 
cently been initiated, employing polio 
and measles virus together with estro- 
gen, progesterone, and other sex hor- 
mones in systems of primary cell cul- 
tures. Definite effects have already 
been observed which encourage further 
work along these lines. 

Measles Virus 

In relation to the development of at- 
tenuated measles virus vaccine it is 
desirable to have additional means of 
identifying attenuated variants from 
virulent, naturally occurring strains. 
Studies along these lines are in pro- 
gress in this laboratory. Several different 
"markers" have been denned, but the 
correlation of these with virulence for 
monkeys remains to be defined. 

Investigation of the relative reac- 
tivity in man of vaccines composed of 
clonal lines of the presently available 
attenuated measles virus has been un- 
dertaken. Stocks of clonal viruses de- 
rived from seed polls for Vaccine A 
and B which have been employed in 
trials in man as well as from virus 
passed thirty times in chick embryos 
have been prepared. According to 
present plans, stock vaccines will be 
manufactured with these stocks and 



tested in small groups of susceptible 
children. 

The well-established fact that im- 
munity against measles is of long 
duration, even in the absence of inter- 
current exposure, has suggested the 
possibility that the agent remains 
latent in the tissues following recovery 
from an attack. Tissues from monkeys 
and human beings with previous his- 
tories of measles are being cultivated 
over long periods in an attempt to 
reveal the presence of measles virus. 

Clinico-virological Studies 

As in the past, patients entering The 
Children's Hospital suspected of suffer- 
ing from viral infections continue to 
be studied by laboratory methods. Since 
the late summer of 1961, over forty 
agents have been isolated from patients 
with a variety of symptoms and are 
at present under study. Enteroviruses 
have been recovered from twenty-seven 
of forty-seven cases of aseptic menin- 
gitis occurring during this period. 

In a study of five cases with 
classical Guillain-Barre syndrome, viral 
agents were isolated from each. In two 
patients, viruses were recovered from 
the spinal fluid which exhibited no 
pleocytosis. Although the viruses iso- 
lated from the five cases were not 
homogeneous in respect to species, the 
association of microorganisms of this 
sort with this syndrome warrants fur- 
ther investigation. 

Studies of rubella patients have 
yielded viral agents using the interfer- 
ence techniques recently reported by 
workers at the Walter Reed Institute 
for Medical Research. This newly de- 
scribed method is being tested as a 
possible aid in the isolation of viruses 
from patients with infectious mono- 
nucleosis. 

Several cases of fatal disseminated 
herpes simplex virus infection of the 
newborn have been investigated in an 



82 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



effort to gain further knowledge of 
the pathogenesis of this condition. A 
complete absence of maternal anti- 
body to this ubiquitous virus seems to 
be the common feature in those infants 
succumbing to this infection. 

An outbreak of respiratory illness 
among Harvard University students 
was investigated in late winter and 
early spring of 1962. Influenza B 
viruses were shown to be the responsi- 
ble agents by both viral isolation and 
serological response among patients at 
the Stillman Infirmary. 

Antiviral Compounds 

A factor has been demonstrated in a 
corynebacterium which interferes with 
the multiplication of several Arbor 
viruses in tissue culture. This depends 
on the inhibition of replication after 
the virus has entered the susceptible 
cell. The substance appears to be a 
protein and is being further investi- 
gated to determine its exact nature, 
site, and mode of action and the range 
of agents inhibited by it. 

One of the 5-halogenated pyrimi- 
dines has been selected for study of 
the effects of this group of compounds 
of in vitro infection with DNA viruses. 
With careful dose-time relationships 
to be observed, this compound 
(I.D.U.) exerts a regular inhibitory 
effect on a number of such viruses 
assayed-herpes simplex, vaccinia, and 
some of the adenoviruses. 

Miscellaneous Studies 

A simple, rapid method for the pro- 
duction of viral antibodies in mice has 
been worked out utilizing Ehrlich 
tumor cells as the source of peritoneal 
fluid containing high concentrations of 
neutralizing antibodies against previ- 
ously injected viral antigens. 

The growth of polio virus strains 
in cotton-plugged monkey kidney cell 
cultures was found to be slower than 



in the usual screw-capped tubes. The 
degree of retardation depended on the 
virus strain and the cell lot. The factor 
responsible was bicarbonate concentra- 
tion and the effect was far more 
marked on attenuated strains than 
virulent ones. The delayed increase in 
virus production resulted from slower 
intracellular synthesis. 

Laboratories of 
Clinical Pathology 

These lines are taken from the sev- 
eral reports prepared during 1962 by 
Dr. Harry Shwachman, Chief of these 
Laboratories. 

In the twelve months ending Au- 
gust 31, 1962, the Laboratories of Clin- 
ical Pathology performed 131,669 lab- 
oratory tests which were recorded for 
billing purposes. This enormous rou- 
tine was carried out by Dr. Shwachman 
and his devoted staff with accuracy, ef- 
ficiency, and commendable speed. This 
Department is responsible also for keep- 
ing various laboratories within the Hos- 
pital complex properly supplied with 
equipment and reagents, and for the 
control of the laboratory tests made in 
all parts of the Hospital. The assignment 
of one medical House Officer to the 
bacteriology laboratory has been good 
for the laboratory as well as for the 
education of the House Officer. It 
should be worthwhile to extend this 
kind of training of the House Officer 
to the laboratories of chemistry and 
hematology and other special labora- 
tory disciplines. Much was gained 
from 1927 until 1940 when a high 
percentage of medical House Officers 
rotated through both the pathology 
and the bacteriology laboratories as 
part of their internship program. It 
was during this period also that large 
numbers of Interns in Orthopedic 
Surgery and general Surgery spent 
from six months to a year in the 
Department of Pathology. 



The Laboratories of Clinical Pa- 
thology have been given high recogni- 
tion from former Residents and from 
the medical community in which we 
live. The Department is called upon 
for the performance of all new pro- 
cedures by doctors in hospitals in this 
part of the country and acts as a 
center of consultation for the clinical 
pathology of early life. Numerous 
patients are referred by pediatricians 
practicing in the community for 
special laboratory procedures. There is 
unfortunately not sufficient space to 
enlarge this important contribution to 
the community. This had been planned 
for when the clinical division was set 
up in 1946 and should constitute an 
important development when new 
space becomes available. The Labora- 
tory of Clinical Pathology is open 
twenty-four hours a day, which makes 
possible important decisions and treat- 
ment at the time when decisions must 
be made quickly. This service is used 
by other hospitals which do not have 
weekend or evening facilities of this 
kind. 

The importance of the Laboratory 
as a source of adequate control of 
chemical and sterilizing processes in 
the Hospital can not be overempha- 
sized. Sterility procedures as related to 
formula preparation and the accuracy 
of preparation of intravenous solutions 
form part of this responsibility. The 
bacteriology laboratory aids in the pre- 
vention of the spread of infection 
throughout the Hospital. Both Dr. 
Shwachman and Dr. George Foley, 
consultant in bacteriology and Chief 
of the Microbiology Laboratories of 
the Children's Cancer Research Foun- 
dation, serve on the Hospital Commit- 
tee on Infections. The vigilance of this 
Committee, based upon die expertness 
of the bacteriology laboratory, is re- 
sponsible for the prevention of many 
infections which might have proved 



83 



CHAIRMAN, DIVISION OF LABORATORIES AND RESEARCH 



fatal or the starting point of epidemics. 
Dr. Shwachman and his staff 
are responsible for constantly de- 
veloping new procedures which prove 
to be of great clinical importance. 
There is a bizarre and unusual 
form of allergy to milk in which 
respiratory symptoms predominate. 
This Laboratory was the first to 
confirm the laboratory and clinical 
observations of Dr. Heiner, a graduate 
of this Hospital, in this field. A case 
in point was that of a baby who pre- 
sented symptoms of constant cough, 
failure to thrive, and irritability. When 
the correct diagnosis was made by a 
positive milk precipitin test and milk 
was removed from the diet, the child 
made a rapid recovery and began to 
eat and grow normally and, in addi- 
tion, became a pleasant, happy child 
in sharp contrast to his previous dis- 
agreeable disposition. Many of the 
recently recognized metabolic dis- 
orders, such as galacosemia, are recog- 
nized by tests performed or perfected 
in this Laboratory. This is true also 
of a metabolic disorder characterized 
by phenylketonuria in children with 
mental retardation. The early recog- 
nition of this condition and the prompt 
institution of a diet to eliminate the 
offending amino acid will result in 
improved growth and development. 
The Laboratory has now undertaken 
the detection of phenylalanine in blood 
to permit the definitive diagnosis in 
instances when the screening proce- 
dures which involve a very simple 
urine test are either positive or ques- 
tionable. It is estimated that approxi- 
mately one per cent of all patients in 
state institutions suffer from this con- 
congenital metabolic abnormality. 
There is scarcely a clinical procedure 
on any one of the Services of the 
Hospital that is carried out today with- 
out the benefit of some information 
from the clinical laboratories. 



Research 

The bibliography gives a good picture 
of the wide variety of investigations 
carried out by Dr. Shwachman and 
his colleagues. The most important 
field of investigation is still cystic fibro- 
sis. Studies have been carried out in 
the field of genetics, biochemistry, bac- 
teriology, and physiology, particularly 
in relation to pulmonary function and 
to the mechanisms of sweating in re- 
lation to pancreatic function. Col- 
laboration with members of the De- 
partments of Surgery, Radiology, and 
Pathology has resulted in important 
progress. This research program has 
served, too, as a training ground for a 
large number of physicians. Dr. 
Shwachman is presently President of 
the Cystic Fibrosis Club and Chairman 
of the Scientific Advisory Board of the 
National Cystic Fibrosis Research 
Foundation. In collaboration with Mr. 
Louis Kopito of Baird Atomic, an 
important improvement in the diag- 
nosis of cystic fibrosis by the recog- 
nition of metals in samples of hair by 
emission spectroscopy was achieved. 
Perfection of this test and proof of its 
accuracy would greatly simplify the 
diagnosis of cystic fibrosis and permit 
recognition of the disease from exam- 
ination of specimens of hair which 
could be sent by mail from all parts 
of the world. Dr. Shwachman and his 
colleagues have reported recently a 
group of fifty patients with cystic 
fibrosis who are alive past the age of 
seventeen. The majority of these pa- 
tients have been studied and treated 
here for over a ten-year period. This 
is a remarkable achievement when it is 
considered that the disease was re- 
garded as universally fatal in infancy 
and early childhood not more than 
fifteen years ago. 

Sidney Farber, M.D. 

Chairman, Division of 

Laboratories and Research 



PUBLICATIONS 

Children's Cancer 
Research Foundation 

Alarcon, R. A., Foley, G. E., and 
Modest, E. J., Effects of spermine on 
mammalian cells. Arch Biochem. 
and Biophys., 94: No. 3, 540-541, 

1961 (Sept.). 

Banker, B. Q., Miller, J. Q., and 
Crocker, A. C, The neurological dis- 
order in infantile Gaucher 's disease. 
Trans. Amer. Neurol. Assoc, p. 43, 
1961. 

Banker, B. Q., Miller, J. Q., and 
Crocker, A. C, The cerebral pathol- 
ogy of infantile Gaucher's disease. 
IN — Cerebral Sphingolipidoses. Ar- 
onson, S. M., and Volk, B., Ed. 
Academic Press, N. Y., pp. 73-99, 
1962. 

Beychok, S., and Blout, E. R., Optical 
rotatory dispersion of sperm whale 
ferrimyoglobin and horse ferrihemo- 
globin. J. Mol. Biol., 3.769-777, 
1961. 

Beychok, S., deLoze, C, and Blout, E. 
R., Helix contents of solutions of 
native and acid-denatured ferrihemo- 
globin and ferrimyoglobin. /. Mol. 
Biol., 4: No. 6, 421-429, 1962 
(June). 

Bloom, S. M., Fasman, G. D, deLoze, 
C, and Blout, E. R., The effect of 
ami no acid composition on the 
conformations of synthetic polypep- 
tides, polymers, and copolymers of L- 
methionine-S-methyl-L-cysteine and 
L-valine. (Polypeptides XXXVII.) 
/. Am. Chem. Soc, 84/458-463, 

1962 (February 5). 

Blout, E. R., deLoze, C, and Asa- 
dourian, A., The deuterium ex- 
change of water-soluble polypeptides 
as measured by infrared spectros- 
copy. (Polypeptides XXXIV.) /. 
Am. Chem. Soc, 83:1895-1900, 
1961. 

Blout, E. R., Helical sense of polypep- 



84 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



tides and proteins. T ' etrahedron, 
13:123, 1961, Pergamon Press Inc. 
, Synthesis and chemical prop- 



erties of polypeptides. IN — Poly- 
amino Acids, Polypeptides and Pro- 
teins. Ed., M. A. Strahmann. Uni- 
versity of Wisconsin Press, Paper 1, 
3-11, 1962. 

-, The dependence of the con- 



formation of polypeptides and pro- 
teins upon amino acid composition. 
IN — Polyamino Acids, Polypeptides 
and Proteins. Ed., M. A. Strahmann. 
University of Wisconsin Press, 
Paper 25, pp. 275-279, 1962. 

Blout, E. R., Farber, S., Fasman, G. D., 
Klein, E., and Narrod, M., Biological 
studies with copolypeptides of L- 
glutamic acid and L-lysine. IN — Poly- 
amino Acids, Polypeptides and 
Proteins. Ed., M. A. Strahmann. 
University of Wisconsin Press, Paper 
36, pp. 379-385, 1962. 

Cardinali, G., Cardinali, G, and Agri- 
foglio, M. F., The colchicine method 
in the study of bone marrow cell 
proliferation. Blood, 18: No. 3, 328- 
335, 1961 (Sept.). 

Cardinali, G, Cardinali, G, Handler, 
A. H., and Agrifoglio, M. F., Com- 
parative effects of colchicine and 
Vincaleukoblastine on bone mar- 
row mitotic activity in Syrian 
hamster. Proc. Soc. Exper. Biol, and 
Med., 207:891, 1961. 

Cardinali, G, Cardinali, G, and Blair, 
J., The stathmokinetic effect of 
Vincaleukoblastine on normal bone 
marrow and leukemic cells. Cancer 
Research, 21: No. 11, pp. 1542- 
1544, 1961 (Dec). 

Clifton, K. H., and Furth, J., Changes 
in hormone sensitivity of pituitary 
mammotropes during progression 
from normal to autonomous. Cancer 
Research, 21: No. 7, 913-920, 1961 
(Aug.). 

Cohen, C, Lowey, S., and Kucera, J., 
Structural studies on uterine myosin. 



/. Biol. Chem., 236: PC23, May, 
1961. 

Cohen, J., and DAngio, G J., Un- 
usual bone tumors after roentgen 
therapy of children. Two case re- 
ports. Am. J. Roentgen., 86: No. 3, 
502-512, Sept., 1961. 

Cohen, M. M., Shklar, G, and Yer- 
ganian, G., Periodontal pathology in 
a strain of Chinese hamsters, Crice- 
tulus griseus, with hereditary dia- 
betes mellitus. Am. J. Med., 31:864- 
867, 1961. 

, Caries incidence and pulpal 

pathology in a strain of Chinese 
hamsters. /. Dent. Res., 12: 1961. 

Crocker, A. C, and Mays, V. B., Sphin- 
gomyelin synthesis in Niemann- 
Pick disease. Am. ]. Clin. Nutrition, 
9:63-67, Jan.-Feb, 1961. 

Crocker, A. C, The cerebral defect in 
Tay-Sachs disease and Niemann- 
Pick disease. J. Neurochemistry, 7: 
69-80, 1961. 

Crocker, A. C, and Farber, S., Thera- 
peutic approaches to the lipidoses. 
IN — Cerebral Sphingolipidoses. 
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Djerassi, I., and Roy, A., Effects of 



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Cancer Research, 21: No. 1, 57-63, 
Jan., 1961. 



CHAIRMAN, DIVISION OF LABORATORIES AND RESEARCH 



Foley, G. E., Handler, A. H., McCarthy, 
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Foley, G. E., Antitumor Antibiotics. 
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Foley, G. E., Handler, A. H., Adams, 
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86 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



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Department of Pathology- 
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, Encephalitis. Clin. path. conf. 

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-, Myoclonus. Clin. path. conf. 

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, Generalized cytomegalic inclu- 
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, Osteogenic sarcoma. Clin. 

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, Cystic fibrosis, severe hypopro- 

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624, 1961. 



87 



CHAIRMAN, DIVISION OF LABORATORIES AND RESEARCH 



, Hashimoto's disease. Clin. 

path. conf. M. W. Hamolsky, dis- 
cusser. J. Pediatrics, .59:777-783, 
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, Tuberculosis. Clin. path. conf. 



E. H. Kass, discusser. 7. Pediatrics, 
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-, Fetal hemorrhage. Clin. path. 



conf. Sherwin Kevy, discusser. /. 
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-, Arthrogryposis and coexistent 



muscular dystrophy. Clin. path. conf. 
Jonathan Cohen, discusser. /. Pedi- 
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-, Total anomalous pulmonary 



venous drainage and stenosis of the 
pulmonary veins. Clin. path. conf. 
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Acute monomyelogenous leu- 



kemia with osteosclerosis and splenic 
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Banker, B. Q., Cerebral vascular disease 
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Banker, B. Q., The experimental my- 
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Banker, B. Q., Miller, J. Q., and 
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Banker, B. Q., Miller, J. Q., and 
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Academic Press, N. Y., pp. 73-99, 
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Byers, R. K., and Banker, B. Q., Infan- 
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Drachman, D., and Banker, B. Q., Ar- 
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Redo, S. F., Farber, S., and Gross, R. E., 
Atresia of the mitral valve. Arch. 
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Research Division of 
Infectious Disease 

Andrewes, C. H., Burnett, F. M., 
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Taxonomy of viruses infecting ver- 
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55, Sept., 1961. 

Berg, R. B., and Rosenthal, M. S., 
Propagation of measles virus in sus- 
pensions of human and monkey leu- 
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, Studies of fibroblastic cells cul- 
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Berkovich, S., Pickering, J. E., and 
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DeMaeyer, E., and Enders, J. F., An 
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Enders, J. F., Vaccination against mea- 
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1962. 



, Measles virus. Historical re- 
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Enders, J. F., Katz, S. L., and Hollo- 
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measles virus vaccines. A summary 
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Enders, J. F., Katz, S. L., and Grogan, 
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Enders, J. F., Kempe, C. H, Krugman, 
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1962. 

Gresser, I., and Enders, J. F., The effect 
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, A note on the presence of in- 
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3, 370-372, March, 1961. 

Gresser, I., Induction by Sendai virus 
of nontransmissible cytopathic 
changes associated with rapid and 
marked production of interferon. 
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208:303-307, 1961. 

Gresser, I., and Kibrick, S., Isolation 
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743-744, Oct. 12, 1961. 

Gresser, I., and Enders, J. F., Cyto- 
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and Med., 107: No. 4, 804-807, 
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Gresser, I., Metamorphosis of human 
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Sci., 47: No. 11, 1817-1822, Nov., 
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, Production of interferon by 

suspensions of human leukocytes. 



88 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Proc. Soc. Exper. Biol, and Med., 
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Gresser, I, and Enders, J. F., Altera- 
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1962. 

Katz, S. L, Enders, J. F., and Hollo- 
way, A., Use of Edmonston attenu- 
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three years' experience. Am. J. Dis. 
Child., 203/341-344, 1962. 

, The development and evalua- 
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Katz, S. L., Morley, D. C, and Krug- 
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Katz, S. L., Measles — its complications, 
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Medical Clinics of North America, 
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Katz, S. L., and Kibrick, S, Non- 
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Pediatrics Clinics of North America, 
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Kibrick, S., Viral infections of the fetus 
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Minis, A., Holloway, A., Evans, A. E., 
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Am. J. Dis. Child., 205:413-418, 
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Mosley, J. W., Dull, H. B, Doege, 
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Mosley, J. W, and Enders, J. F. A 
critique of the plaque assay tech- 



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Mosley, J. W., Multiplication and 
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Mosley, J. W, and Enders, J. F., 
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Shein, H. M., and Enders, J. F., Multi- 
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, Transformation induced by 

Simian virus 40 in human renal cell 
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Shein, H. M., Enders, J. F., and Levin- 
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Shwachman, H., Katz, S. L., Kulczycki, 
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205:405-409, March, 1962. 

Laboratories of Clinical 
Pathology 

Clarke, J. T, Elian, E., and Shwach- 
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Clarke, J. T., Colorimetric determina- 
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Chem., 7: No. 4, 271-283, Aug., 
1961. 

Elian, E., Shwachman, H., and Hen- 
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of the newborn infant. Usefulness 
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Ghadimi, H., Clarke, J. T, and Shwach- 
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Kulczycki, L. L., Mueller, H., and 
Shwachman, H., Respiratory allergy 
in patients with cystic fibrosis. 
J.A.M.A., 27.5:358-364, Feb. 4, 
1961. 

Shahidi, N. T., Diamond, L. K., and 
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59: No. 533-542, Oct, 1961. 

Shwachman, H, Katz, S, Kulczycki, 
L. L, Attenuated measles vaccine in 
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205:405-409, March, 1962. 

Shwachman, H, The sweat test. Pedi- 
atrics, 50:167, 1962. 

Shwachman, H, and Antonowicz, I, 
Problems in cystic fibrosis. The 
sweat test in cystic fibrosis. Ann. 
N. Y. Acad. Sci., 95:600-620, 1962. 

Schwachman, H, Kulczycki, L. L, 
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polyposis in patients with cystic 
fibrosis. Pediatrics, 50:389, 1962. 



89 



PSYCHIATRIST-IN-CHIEF 



REPORT OF 
PSYCHIATRIST-IN-CHIEF 

n T — — < --.... ■ w—lj. -m a n 1 1 HB g TT^^wawTH^r, M ■■ 

Introduction 

In the year 1962 the Psychiatry De- 
partment had its busiest year since its 
establishment nine years ago. As will 
be noted in the detailed report below, 
plus the accompanying tables, the 
actual work done in service to children, 
training and education, and research 
has shown a definite growth and ex- 
pansion since the time of our last 
report to the Trustees two years ago. 
As was emphasized in my last 
report, it is extremely difficult to sepa- 
rate the psychiatric, clinical psychology, 
and psychiatric social work activities of 
the Department of Psychiatry in the 
Hospital from those being carried out 
in the affiliated Judge Baker Guidance 
Center situated across Longwood 
Avenue. Since the Judge Baker became 
located in its new quarters across the 
street, with its out-patient division, in- 
patient division, and Manville School, 
many functions of this Department 
have been coordinated with — or inte- 
grated into — those carried out by 
analagous professional personnel in the 
Judge Baker units. This will be seen 
to be particularly true in reference to 
training, education, and research. 

Service 

Psychiatric and psychological service 
has continued to be offered to the chil- 
dren referred to the C H. M. C. 
through the central clinic which is lo- 
cated on the second and third floors of 
Building A. From this central clinic the 
service needs of the MOPD, the Ado- 
lescent Unit, and the various in-patient 
wards and units of the Hospital have 
been met through assignment of per- 
sonnel designated to care for specific 
area needs. 

As will be noted from the statisti- 
cal chart, the diagnostic, consultation, 
and treatment services offered to the 
children of the Hospital community 
were increased during the year. In 
spite of this increase it is well to 



bear in mind that the full-time and 
part-time personnel of the Depart- 
ment were still unable to meet the 
demands of the physicians on other 
services of the Hospital for psychiatric 
diagnostic and treatment work. Hence 
there always has been a waiting list 
of patients to be served in all disci- 
plinary categories of the Department. 
These unmet needs are particularly 
apparent when one considers the wait- 
ing list for psychiatric treatment and 
psychological testing and evaluation, 
and although the Department has by 
specific policy confined its service func- 
tions to those children who are 
"C. H. M. C. patients," it is evident 
that it will be many years at least, be- 
fore Deparment personnel sufficient to 
meet these needs will be available to 
the Hospital staff as a whole. (It 
should be added, parenthetically, that 
this condition of mental health man- 
power shortage and financial limita- 
tions obtains in all of the child psychi- 
atric facilities in Boston, even though 
in the number of its accredited and 
approved child psychiatry clinics this 
city has a far greater number than any 
other city in the country.) 

However, in spite of these short- 
ages and its stated policy of priorities 
for C. H. M. C. patients, the Depart- 
ment works cooperatively day after 
day with schools, courts, and agencies 
in the community in an attempt to 
secure service to forward and ensure 
the mental health of children and the 
parents of children. If our work 
through consultations and diagnostic 
evaluations indicates that a child or its 
parent needs help, our clinic teams 
(psychiatrist, psychologist, and psychi- 
atric social worker) do their very best 
to refer the child for initial or con- 
tinued psychotherapy or social case 
work help elsewhere. Finally, the mem- 
bers of the Department have always 
held themselves available to pediatri- 
cians, private practitioners, and others 



90 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



inquiring for help who wish to have 
suggestions and guidance in respect to 
referral of their patients to private 
child psychiatrists in the community. 
Requests of this nature number in the 
scores each year and it is our policy 
to do our best to find psychiatrists for 
those who wish to get — and can afford 
— private treatment. 

Training 

Child Psychiatry 

As in past years, we have continued 
the coordinated training program for 
the specialty of child psychiatry. Dur- 
ing the past year we have had a total 
of nine physicians in training for this 
medical specialty, three in their second 
year of training and six in their first 
year. It is to be remembered that all 
of these physicians have had at least 
two, and sometimes three, years of 
training in general or adult psychiatry 
before coming to us, and the majority 
of them have had a year of training in 
pediatrics. In addition to the above 
full-time Residents who are being 
trained specifically for work with chil- 
dren, we have had two Junior Assist- 
ant Residents who were with us for 
part-time orientation and training in 
the field of child psychiatry as an ad- 
junctive or integral part of their three- 
year training in general psychiatry. 

During this year we received a 
generous training grant from the Na- 
tional Institute of Mental Health for 
the training of Board certified or Board 
qualified pediatricians, and two of them 
have taken advantage of this educa- 
tional program. This new and special- 
ized program is a part of the NIMH's 
General Practitioners' Training Pro- 
gram which has been established in 
various medical centers throughout the 
country and it is expected that these 
programs now open to pediatricians 
will expand in numbers and signifi- 
cance in the years ahead. 

Through our affiliation with the 



Judge Baker, the content of the train- 
ing program in child psychiatry is 
diversified and comprehensive. Both in 
their clinical work and in their didac- 
tic seminars, opportunities are offered 
to the Residents to become acquainted 
with the psychiatric problems pre- 
sented by children in both a hospital 
setting and in a community child 
guidance center. The case types, diag- 
nostic classifications, and age levels of 
children coming under their supervised 
care are varied, so it is possible for 
them to gain experience with children 
exhibiting the severest behavioral devi- 
ations, as well as with children whose 
disabilities are developmental or transi- 
tional in nature. Finally, the intensive 
work with patients on the in-patient 
division of the Judge Baker offers them 
the opportunity to broaden their 
training experience the better to equip 
themselves to practice their specialty 
in both in-patient and out-patient 
mental health settings for children and 
adolescents. 

Clinical Psychology 

During the past year the Division of 
Clinical Psychology has had five pre- 
doctoral candidates in training in clini- 
cal psychology. These trainees are recip- 
ients of United States Public Health 
Service stipends from the NIMH and 
come to us from graduate departments 
of various universities. In addition, 
there were two students from the grad- 
uate programs at Harvard University 
and Boston University who received a 
year's experience as clinical clerks in 
psychology. These students combined 
their clinical work with the academic 
work of their second and third years 
of graduate study. The content of their 
clinical work with us is aimed at giving 
them as wide an experience as possible 
in psychological testing and individual 
counselling, plus acquainting them 
with possibilities for research with 
children with emotional problems. 



Finally, there were two post-doctoral 
trainees in this discipline with us in 
the past year. In this training program, 
too, our aim is for the widest possible 
variation and diversification of case 
types, including children with emo- 
tional difficulties, educational problems, 
and children with organic brain 
diseases. 

Psychiatric Social Work 
The Division of Psychiatric Social 
Work continues to be a training area 
for social case workers in the C. H. 
M. C. During the year, we have had 
three students in training, one each 
from Simmons, Boston University, and 
Boston College Schools of Social Work. 
Psychiatric social workers are trained 
to work in close collaboration with the 
psychiatrist and psychologist as a 
member of a clinic treatment team and 
their special area of work is that which 
deals with the coordinated treatment of 
the parents of the emotionally dis- 
turbed child. It is important to bear 
in mind that psychiatric treatment of 
children invariably does involve the co- 
ordinated and simultaneous treatment 
of the parent or parents of the child. 
To carry out this function relative to 
effecting the beneficial changes in the 
child-rearing practices of parents, the 
psychiatric social worker plays a most 
important role; and parents are seen 
as often as is the child. 

Education 

The many and varied mental health 
educational activities of the members 
of the Department of Psychiatry are 
carried out, in the main, in conjunc- 
tion with the Harvard Medical School; 
the Harvard Department of Social 
Relations, both at the graduate level 
and undergraduate level for students 
in Harvard University and Raddiffe 
College; and with the Harvard Gradu- 
ate School of Education. 



91 



PSYCHIATRIST-IN-CHIEF 



Harvard Medical School 
First Year. The members of this De- 
partment at the Judge Baker and the 
C H. M. C. offer lectures and clinics in 
that segment of the first year cur- 
riculum entitled "Growth and Devel- 
opment." These lectures, with illustra- 
tive clinical material, stress normal 
personality growth in children. The 
various tasks in personality develop- 
ment set for the child are outlined, 
together with the crises and threats 
that may block or divert the normal 
process of maturing. 
Third year. To the third year medical 
students, six lectures are given on the 
most frequently encountered childhood 
neuroses and psychoses. A two-hour 
seminar each month is also given to 
students in their pediatric program at 
the Hospital. 

Fourth Year. In association with the 
Department of Medicine of The Chil- 
dren's Hospital, there are weekly clini- 
cal exercises on the responses of chil- 
dren to the effects of hospitalization, 
and a two-hour session held with the 
fourth year students at the Massachu- 
setts Mental Health Center, dealing 
with the problems of adolescents. Also 
in association with this Department 
we supervise psychiatric teaching of 
fourth year medical students in the 
Well-Child Clinic and Family Health 
Care Program. 

There is a month's elective course 
in child psychiatry offered at the Hos- 
pital to the fourth year medical stu- 
dents. In this course the students 
interview both child patients and their 
parents and take part in the psychiatric 
consultations of staff members with 
patients on the wards. They also at- 
tend teaching conferences at the 
C. H. M. C. and at the Judge Baker 
across the street. 

Harvard University Department 

of Social Relations 

In the past year, five students at the 



second year graduate level have been 
assigned to The Children's Hospital 
Department of Psychiatry-Judge Baker 
for an internship in clinical psychol- 
ogy through the academic year. 

Two hour-long graduate seminars 
in clinical child psychology are given 
each week throughout both fall and 
spring terms. The second year graduate 
students in the Division of Clinical 
Psychology of the Department of So- 
cial Relations are required to take these 
seminars. These seminars include the 
orientation of the student in clinic 
practices and offer instruction in the 
diagnosis and counselling of child pa- 
tients and their parents. 

Two courses to which under- 
graduates at Harvard and Radcliffe 
are admitted are given in the Depart- 
ment of Social Relations by members 
of our Department, each of which was 
taken by approximately fifty students 
this year. One of these, "Social and 
Psychological Aspects of the Practice 
of Medicine," given by Dr. Croog 
and myself, is offered to pre-medi- 
cal students and to seniors concentrat- 
ing in Social Relations. Other members 
of the Hospital Staff, besides those in 
the Psychiatry Department, assist in 
offering this sequence of lectures on 
medical care in the various countries 
throughout the world and on the mean- 
ing of disease to the patient and the 
patient-doctor relationship. 

Harvard Graduate School 
of Education 

Three members of the Department of 
Psychiatry hold lectureships in the Har- 
vard Graduate School of Education. 
Their duties in course-work in Cam- 
bridge and their clinical supervision of 
students at the Hospital and at the 
Judge Baker have as goals the educa- 
tion and training of graduate students 
in the field of educational psychology 
(with emphasis on testing, evaluation, 
and diagnosis) and psychological coun- 



selling. During the past year, four 
students were accepted for the clinical 
training sequence in this coordinated 
program. 

In commenting on the education 
of professional personnel relative to 
personality development and psychi- 
atric treatment of children we felt that 
more than passing emphasis should be 
placed upon the importance of the 
instruction given by members of the 
Department of Psychiatry to profes- 
sional personnel within the Hospital 
who are members of other disciplines. 
Most important among these educa- 
tional endeavors are those relating to 
the instruction of Residents daily in 
medicine and surgery on all the wards 
of the Hospital in connection with 
consultative work by members of this 
Department. Added to this is the day 
by day instruction of, and conferences 
with, the medical Residents in the 
Medical Out-Patient Department. It 
is instruction at close range and in 
respect to specific cases needing treat- 
ment which seems to us to have the 
greatest value in acquainting non- 
psychiatric physicians with the mean- 
ing and management of children suffer- 
ing from behavioral disabilities and 
disorders. As stated above, more for- 
mal instruction is given in weekly 
case presentations by the medical Resi- 
dents to the Psychiatrist-in-Chief and 
his associates each Friday morning 
throughout the year and daily in the 
Well-Child Division of the Depart- 
ment of Medicine. In this latter teach- 
ing area medical students, nurses, and 
Residents also are in attendance. 

Finally, the Department members 
take an active part in the education of 
non-medical professional personnel 
who have the responsibility for the day 
by day care of children in the Hospital, 
and the responsibility for the guidance 
of parents of sick children. Members 
of our Department give courses and 
clinical demonstrations to members of 



92 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



the Social Service Department who 
work in the medical and surgical areas 
of the Hospital, the nurses who are 
affiliated in training in our School of 
Nursing, members of the Department 
of Patient Education and Recreation, 
and trainees at the Hospital in the field 
of physiotherapy. Less formally, lec- 
tures are given on occasion by members 
of the Department to parent groups 
who meet under the aegis of other De- 
partments in the Hospital for group 
instruction relative to the care of chil- 
dren suffering from various disease 
conditions, e.g., seizures, hemophilia, 
diabetes, etc. 

Research 

Members of the Psychiatry Department 
have continued and extended their re- 
search activities and interests during 
the past academic year. A list of publi- 
cations from the Department is ap- 
pended to this report. The greatest 
research opportunities for psychiatrists 
and psychologists working in a chil- 
dren's hospital setting deal with items 
relative to child growth and develop- 
ment and to those factors causing 
deviations in, or alterations of, the 
maturation process. In keeping with 
these almost unlimited opportunities, 
our present research and that projected 
for the future has specific reference to 
this area of investigation. Thus our 
projects deal with both the general 
blocks to personality development as 
evidenced in serious learning disabili- 
ties and also are concerned with the 
effect of specific physical disabilities 
upon various parameters of personality 
growth. Specific projects being carried 
out in these multi-varied areas are as 
follows: 

Following the exploratory and 
pilot phases of their research men- 
tioned in our last report, Drs. Geral- 
dine Rickard and Haskel Cohen 
received support for their research from 



the National Association for Mental 
Health through a three year grant end- 
ing in 1964. These investigators are 
developing a psychological test to de- 
termine children's progress in selected 
tasks of emotional development 
through childhood. This study should 
furnish us with much-needed norm- 
ative data regarding personality devel- 
opment and enable us to detect devia- 
tions in their earliest stages through 
the medium of objective tests and 
measures. 

Dr. Marvin B. Krims is carrying 
out an ongoing psychiatric study of 
children with abnormalities in physical 
growth and development due to endo- 
crinological disturbance. This study is 
a collaborative project with the Endo- 
crine Clinic. Most of the children 
studied fall into two groups: those 
with markedly advanced and precocious 
physical development, the so-called 
precocious puberty group, and those 
with markedly retarded physical 
growth. The study is designed both to 
shed light on the emotional problems 
and responses of such children in order 
to promote the total care of the chil- 
dren themselves, and to clarify the psy- 
chological growth of normal children. 

Environmental influences on in- 
fant vocalization were studied by Dr. 
Eric H. Lenneberg. Details of the ap- 
paratus and technique were published 
elsewhere. Babies were followed from 
birth to the first three months at bi- 
weekly intervals, with twenty-four 
hour tape recording at each observa- 
tion. Data include quantitative and 
qualitative variables in the baby 
noises, as well as quantitative and qual- 
itative variables in those noises to 
which the baby was exposed. All sub- 
jects were well babies, ten of whom 
were born into normal homes and six 
born to congenitally deaf patents. The 
congenitally deaf parents could not 
speak and usually did not know 



whether a child was making any kind 
of sound. Thus chances for reinforce- 
ment for vocalization and opportunity 
for direct imitation were dramatically 
reduced in the experimental group. He 
and his co-investigators, Freda Rebel- 
sky and Irene Nichols, are just now 
completing analysis of the last data and 
expect to have the investigations writ- 
ten up by summer. 

Language development in Mon- 
golism was the subject of a three-year 
project conducted by Dr. Lenneberg 
and Irene Nichols and Eleanor Rosen- 
berger now completed and written up. 
These children are interesting because 
of their slow development, their gross 
mental deficit, and their inability to 
learn from the experimenter during the 
examination. For further details see the 
write-up. 

Dr. Lenneberg, in cooperation 
with Dr. Joseph Winston, a surgeon at 
the Boston Dispensary and Rehabilita- 
tion Institute, is studying patients who 
have suffered traumatic division of the 
median nerve at the level of the wrist. 
The nerve is sutured end to end and 
return of sensation in the inner aspect 
of palm and affected digits is studied 
periodically. Of special interest is the 
patient's ability to localize points of 
sensation. It is assumed that normally 
there is a point by point representa- 
tion of the skin (and particularly the 
hand) on the cerebral cortex. (Sensory 
maps by Penfield.) When the nerve is 
divided and sutured again the thou- 
sands of axons and fibres will neces- 
sarily be disarranged anatomically so 
that the former cortical map is no 
longer isomorphic with the nerve end- 
ings after regeneration. The question is 
whether in the return of sensation a 
new and orderly topographical reor- 
ganization develops, or whether the 
patient can learn, by training, to refer 
sensations to the correct location in the 
hand. 



93 



PSYCHIATRIST-IN-CHIEF 



A somewhat similar study of 
sensory-motor coordination after surgi- 
cal disarrangement is also being con- 
ducted by Dr. Lenneberg. Subjects 
are patients with surgical reconstruc- 
tion after trauma, particularly where 
transfer of digits or transfer of 
neurovascular island flaps were per- 
formed. Tests consist of motor re- 
sponses to somesthetic stimulation. 
How well can a patient learn that a 
sensation that was formerly associated 
with, say, the ring finger, must now be 
referred to the thumb? 

During the summer of 1961 a 
Harvard Medical student, Sam Put- 
nam, took part in an expedition to 
New Guinea where he gathered sound 
samples of infant vocalizations of the 
tribe which he visited. Subsequently, 
several people in the Department of 
Anthropology at Harvard have shown 
interest in pursuing this work further 
and more extended collection of infant 
vocalizations and speech development 
is contemplated. From March until 
November of 1963, Mr. Karl Heider 
from Harvard's Peabody Museum will 
again be in New Guinea in the Grand 
Valley where he hopes to study approx- 
imately two dozen children of various 
ages. For each child he will take care- 
ful anthropometric measurements, ad- 
minister a test of motor development 
(Nancy Bailey's), make high-fidelity 
sound recordings of vocalizations, and 
in addition, discuss the child's language 
progress, his customary mistakes and 
his manner of speech with adult in- 
formants. In 1964 two other anthro- 
pology students, Eleanor and Christo- 
pher Crocker, will be going to Central 
Brazil to study the Xingu Indians 
under the direction of Dr. Maybury- 
Lewis. Mrs. Crocker is now working 
in Dr. Lenneberg's laboratory in Bos- 
ton in preparation for her field work 
next year. Further, Dr. Lenneberg 
plans to do comparable field work this 



summer in the Ramah area on the New 
Mexico-Arizona border. He has been 
invited to do this work under the aus- 
pices of the Indian Museum in Santa 
Fe which is beginning a social-anthro- 
pological field station under the direc- 
tion of Dr. Nicholas Colby; in order 
to be able to make use of the museum's 
contacts with Indians he will be given 
a courtesy appointment in the museum 
for the duration of his work. 

During the last few years a great 
deal of preliminary research has gone 
into the planning of a study of deaf 
children's acquisition of language, par- 
ticularly grammatical rules. Dr. Len- 
neberg and his associates have 
investigated the grammar of their 
spontaneous writings as well as their 
responses to specific tests of their lan- 
guage skills. He and his associates are 
now ready to start a broad and well- 
controlled investigation of language 
acquisition in the deaf. Three school 
populations can be used, and for every 
child in these schools history and medi- 
cal data will be gathered and trans- 
ferred to an I.B.M. card and then 
correlated with the results of the care- 
fully administered language acquisition 
test. 

Dr. Lenneberg is presently con- 
ducting an investigation into the physi- 
ological basis of rate and rhythm of 
articulatory movements during speech. 
Special equipment has been devised for 
this purpose, and in April 1962 he en- 
gaged the services of an electronic 
consulting firm, Bolt, Baranek and 
Newman, to write a program for a 
high-speed electronic computer which 
is presently processing his data. 

During the past year, Dr. Felix 
Deutsch and Dr. Tully Benaron, with 
the collaboration of other members of 
the Department, have continued their 
intensive study and analysis of draw- 
ings and paintings of children mani- 
festing certain psychosomatic disorders. 



The pictographic productions of these 
children are studied from the point of 
view of their relevance to their sym- 
bolic meanings that, in turn, have rele- 
vance to diagnosis and prognosis of the 
clinical condition. Analyses of these 
data have also demonstrated their sig- 
nificance relative to the body image of 
the child and in respect to the matura- 
tion of mental processes. 

A detailed resume of the very 
significant research activities of Dr. 
Peter H. Wolff and his research asso- 
ciates dealing with numerous param- 
eters of infant and child development 
compiled by Dr. Wolff for this report 
to the Trustees is as follows: 

"Since the time of my last report 
in 1961, progress in developmental 
studies has been made in several areas. 

"The second monograph on ne- 
onatal behavior was accepted in its 
submitted form in the Psychological 
Issues Monograph Series. In that mono- 
graph I reported a cross-sectional study 
on newborn infants: the data are 
systematically presented in statistical 
form, while the lengthy theoretical dis- 
cussion that follows is intended as a 
basis for longitudinal studies in devel- 
opmental terms. Just as my original 
monograph was intended as a broad 
theoretical statement to serve as a pro- 
gram of developmental studies on 
emotional expression, so this mono- 
graph is intended to provide the 
empirical basis of neonatal behavior 
patterns on which my further observa- 
tions are based. The data analysis of 
observations beyond the neonatal period 
(from zero to three months) has been 
completed only in part, and my major 
writing activity at present is committed 
to the analysis of protocols from daily 
observations of infants in their homes. 
So far two longitudinal studies have 
been written up and will appear as 
separate chapters in the Ciba Sym- 
posium. 



94 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



"The developmental study of smil- 
ing behavior in Mongoloids and con- 
genitally blind children, at the Walter 
Fernald School, has made headway. Dr. 
Sadako Imamura and I have followed 
social responsiveness of these children 
longitudinally over the past nine 
months (youngest Mongoloid three 
months, oldest fourteen months). We 
have collected comparative data on the 
chronological sequence in the develop- 
ment of smiling that parallels my 
observations on the development of 
smiling in normal infants from zero to 
three months. 

'The work on smiling is carried 
out simultaneous with a study of the 
development of stereotype behaviors 
in institutionalized children (in this 
case, for example, Mongoloids and blind 
children). We are making detailed 
descriptions of stereotypies from month 
to month to follow their behavior, and 
recently have begun to film this 
progress by movies. Preliminary results 
indicate the expectable finding of a 
lawful and predictable sequence in the 
varieties of stereotypies in these chil- 
dren paralleling their general motor- 
coordination development. We believe 
that such data eventually will give us 
some clues about the 'adaptive signifi- 
cance' of stereotype behaviors in feeble- 
minded, autistic, and blind children. 

"Dr. Imamura and I have been im- 
pressed with the broad range of varia- 
tion in motor coordination and social 
responsiveness among the Mongoloids 
we are observing. Because of this wide 
range in social behaviors we have 
raised the question whether the more 
advanced and appealing children are 
socially so responsive because they have 
been "adopted" by one of the nurses 
on the floor so that their social behavior 
has advanced more rapidly because of 
environmental stimulation; or whether 
the advanced children are simply less 
defective and therefore are more ap- 
pealing to the nursing staff. To attempt 



a partial resolution of this problem we 
have recently initiated a pilot study in 
which we have hired a young woman 
who has had experience caring for a 
Mongoloid; her sole task is to provide 
mothering care regularly for two of 
the four most retarded Mongoloids over 
a period of two months while the other 
two severely retarded Mongoloids serve 
as controls. After the two-months period 
we will re-test the children's social re- 
sponsiveness by the measures already 
developed, by the complexity and quan- 
tity of their stereotype behaviors, and 
by their responses to the appearance 
and disappearance of the care-taking 
person (as recorded on film). Because 
there appears to be a distinct overall 
difference between the most advanced 
and the most retarded Mongoloids' in- 
tellectual and social behavior, we have 
arranged to do chromosome studies on 
several of the children at both ends of 
this behaviorial continuum in order to 
explore whether the differences may be 
due to variations in chromosome ab- 
normality. If this exploratory study 
should prove promising, I am consid- 
ering more detailed studies on the rela- 
tion between chromosome abnormality 
and the level of social and intellectual 
performance in these as well as other 
congenital defects, these to be related 
to structural abnormalities in chromo- 
some patterns. This approach may 
eventually make it possible to under- 
take an investigation of behavioral gen- 
etics on young subjects without the 
many methodological complications in- 
troduced by co-twin studies, population 
surveys, etc. 

'Together with Doctor Irving Hur- 
witz, of the Judge Baker Guidance 
Center, I have followed up H. F. R. 
Prechtl's finding that the 'choreatiform 
syndrome' (a complex of behavioral 
disturbances such as impulsivity, motor 
restlessness, learning difficulty, short at- 
tention span, etc.) and physical symp- 
toms (brief intermittent myoclonic 



twitches of the distal skeletal muscula- 
ture) are significantly related to peri- 
natal anoxia of the newborn. 

"Our core study in this respect in- 
cludes a survey of the Newton gram- 
mar and junior high school population 
from the fifth through the eighth 
grades. In this group we have surveyed 
more than 1,500 children for the 
presence or absence of the choreati- 
form twitch. At the same time, Dr. 
Elizabeth Makkay and her associates 
from the Judge Baker have surveyed 
the same population from a behavioral 
point of view, and have so far selected 
a group of 450 children who were 
referred to them by teachers because 
of various disturbances such as learn- 
ing problems, impulse behavior, early 
signs of delinquency, etc., for more 
detailed study. At present we are cor- 
relating our incidence survey with that 
of Dr. Makkay's tabulations of be- 
havior and developmental difficulties. 
Our anticipation is that a high percent- 
age of the children we have diagnosed 
as positive by a simple physical diag- 
nostic test, will also appear in the 
sample selected by Dr. Makkay for 
more intensive study because of re- 
ported psychopathology. Since in both 
methods of selection the degree of 
severity of disturbance was included as 
part of the scoring method, we believe 
that the correlations can be carried out 
in a semi-quantitative fashion. 

"Last summer Dr. Hurwitz and I 
surveyed the total population of chil- 
dren attending Dr. Young's summer 
camp — Camp Wediko — for children 
with severe behavior disturbances. This 
group was particularly suitable for our 
study because detailed medical, devel- 
opmental, and psychological histories, 
as well as the birth records, are avail- 
able for review. In this camp we found 
that 67% of the children have chore- 
atiform twitch (as opposed to 5% to 
7% in the normal population), and 
this summer a graduate nurse working 



95 



PSYCHIATRIST-IN-CHIEF 



with us will review the developmental 
histories of all the children at the 
camp, to establish the correlation be- 
tween those found with behavioral 
development and evidence of early dis- 
turbance on the one hand, and the 
physical symptom on the other hand. 

"A survey of delinquent boys de- 
tained at the Youth Service Board 
shows the choreatiform twitch in about 
one-third of that population; Dr. Hur- 
witz is at present correlating the find- 
ings with his own studies of motor 
coordination (as measured by the 
Oseritzki Test). A similar survey of 
the resident population of the Judge 
Baker Guidance Center — children 
who are placed here primarily for 
learning difficulties but have also a 
wide range of other psychological dis- 
turbances — indicates a similar 30% 
incidence of the physical sign, although 
most of these children had previously 
been diagnosed as neurologically nor- 
mal. 

"The significance of our results 
rests on the fact, we believe, that the 
overall incidence of this twitch in a 
presumably normal population at the 
Newton High School System does not 
exceed 5-7% and that the much larger 
incidence of this minim al neurological 
symptom may well correlate with a 
variety of behavioral disturbances. At 
present we have no intention to assume 
that there is a direct cause and effect 
relationship between the behavioral dis- 
turbance and the twitch, but only a par- 
tial determination. We have made prep- 
arations to check our clinical diagnoses 
by objective measures, and are now 
prepared to test a randomly selected 
number of children by electromy- 
ography. 

"As an outgrowth of my studies of 
neonatal behavior, I have becomeTn- 
terested in studying the sucking pat- 
terns of newborn babies, while they are 
in deep sleep. In this organismic state 



the sucking behavior shows a high 
degree of regularity and constancy 
which makes the measurement of suck- 
ing a potentially useful tool to study 
individual differences between normal 
newborns, diagnostically significant dif- 
ferences between normal and brain- 
damaged infants (for example, chil- 
dren with minimal brain damage 
whose illness is not otherwise diag- 
nosed), and 'congenital' biological 
rhythms which determine sequential 
behavior patterns such as rhythmical 
sucking, etc 

"I have completed a preliminary 
study of sucking patterns in deep 
sleep on twenty children; this study 
was focused on the patterns or rhythms 
themselves (the frequency of sucks per 
second, the distribution of sucks over 
time, the alternation of rhythms by 
hunger and other adventitious stimuli) 
and I have explored various experi- 
mental techniques for modifying the 
'inherent' rhythm by such devices as 
photic flashes and metronome sounds. 
At present I am working out tech- 
niques by which to record these suck- 
ing patterns in sleep in such a way that 
they can be analyzed electronically, 
since the making and analyzing of 
individual tapes is a time-consuming 
procedure (although it did show us 
which parameters of sucking behavior 
were the significant ones for study). 

"For the summer period, a first 
year medical student and I have re- 
turned to a project for which I have 
been collecting preliminary data during 
the past eighteen months. The project 
concerns the observation of infants 
being fed by gastrostomy because of 
various surgical anomalies. The ques- 
tions which we hope to clarify in part 
are the following: 

"First, if a newborn baby has 
never had a satisfactory experience of 
sucking (in terms of hunger reduc- 
tion), does the sucking mechanism 



remain intact, are the patterns of suck- 
ing the same as those in a normal 
infant of comparable age, or does the 
fact that such infants receive no food 
in response to their sucking efforts 
impair sucking behavior? In particular 
we will record the sucking pattern on 
the first occasion after such infants are 
allowed to suck on a sugar nipple 
(about ten days after surgery and 
twelve days after birth), and after a 
period during which their only possible 
exercise of sucking would have been 
with their own fingers; after they have 
practiced sucking for several days, but 
before they receive food by the oral 
route; and after the first day of nutri- 
tional sucking. 

"Second, the obscurity, despite 
many animal experiments and clinical 
observations, of the 'arousal' factor of 
hunger. Neither blood sugar nor gastric 
peristalsis appears to influence the in- 
fant's behavior in a way to suggest that 
they are the critical factors associated 
with what the observer would identify 
as 'hunger-behavior.' Using the in- 
fants with gastrostomy tubes, we in- 
tend to control the variable of gastric 
distension (which seems to be directly 
correlated with behavioral manifesta- 
tions of hunger) by replacing the usual 
gastrostomy tube by a Miller-Abbot 
Tube on the tenth day and, as the 
food ingested leaves the stomach, to 
make up the decrease in volume of 
milk with a corresponding volume of 
water in the Miller-Abbot balloon, 
thus keeping the absolute volume of 
gastric contents relatively constant. 
We will record the sucking patterns 
and the duration of sleep and waking 
as dependent variable. 

"And third, we will explore the 
questions inherent in the ethological 
assumption of 'instinct-specific ener- 
gies' or motivations. Once the infant 
takes his feeding by mouth, but before 
the gastric tube is removed, we will 



96 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



carry out 'sham-feeding' experiments in 
which immediately after a feeding we 
will remove all the food the infant has 
taken. If the ethological assumption is 
correct, the infant on a sham feeding 
should behave like a fed infant; if not, 
his behavior would indicate that he is 
hungry. We also plan to carry out the 
sham-feeding experiments, but main- 
tain a constant volume of gastric con- 
tents through the Miller- Abbot Tube. 
"As an outgrowth of the chromo- 
some studies on Mongoloids, Dr. Park 
Gerald, from the Clinical Genetics 
Laboratory, and I have begun a pilot 
study on the psychological functions of 
children and parents with unusual 
chromosome defects. The first develop- 
mental studies on pre-verbal infants 
have been started with the help of Dr. 
Marion Fiedler and Mrs. Annette Sil- 
bert, of the M.I.H. project, and we 
hope to develop a systematic longi- 
tudinal follow-up program of psycho- 
logical development in children with 
chromosomal abnormalities. I expect 
that this area of research may in time 
expand into a major effort; at the 
present we have intentionally kept the 
scope of the study small to work out 
proper testing techniques and to select 
carefully which of the myriad of ge- 
netic defects it will be most profitable 
to study from a developmental point 
of view." 

Future Needs and Items 
For Discussion 

In the foregoing survey I have outlined 
the treatment, training, and research 
activities and programs of the Depart- 
ment of Psychiatry of The Children's 
Hospital Medical Center in the year 
October 1961 to October 1962. I have 
stressed those activities and work of 
the Department's personnel in the Hos- 
pital proper and have included the 
coordinated work with the affiliated 
Judge Baker Guidance Center. In 



conclusion, I would like to list needed 
new programs or needed expansion of 
existing programs that would add to 
our effectiveness in dealing with the 
mental health problems and behavioral 
deviation of children. 

There is need for a modest num- 
ber of beds in The Children's Hospital 
with proper facilities for the care of 
child psychiatric emergency cases that 
are from time to time brought to our 
out-patient or emergency clinics, or 
that develop in the Hospital on one or 
another service. Although we have 
twenty-six beds on the in-patient serv- 
ice at the Judge Baker, we are not 
equipped either by ward structure or 
personnel to handle the youngster who 
presents an acute behavioral emer- 
gency. The value of an in-patient unit 
of this type as a training and research 
area also should be emphasized. 

We definitely need expansion of 
the psychiatric treatment and research 
personnel and facilities to include the 
infant and pre-school child, psychologi- 
cal testing programs, and, especially 
programs of training for clinical psy- 
chologists who may, we hope, become 
specialists with this particular age 
group. 

There is a need to include mental 
health principles and mental health 
personnel in the recreational and edu- 
cational programs for in-bed and con- 
valescent patients. 

With the establishment of the 
new Department of Neurology it is 
hoped that cooperative schemes of 
training, treatment, and research will 
go forward. It seems to me that with 
an expanded and definite Neurology 
Department the widest spectrum of 
cases of both the organic neurological 
and the emotional-behavioral type could 
be cared for within our own Children's 
Hospital Medical Center. It presents 
an opportunity for a broad and eclectic 
treatment program, and for a training 



and research approach to these disabili- 
ties of childhood. 

The possibilities for the appoint- 
ment of one or two full-time psychia- 
trists to our staff should be explored 
seriously. In the Department of Psy- 
chiatry — as in some of the other 
departments of the Hospital — the 
lack of outstanding "personnel in 
depth" constirutes, to my mind, a 
serious situation in the evolvement of 
future treatment and research programs 
and in the maintenance of a Harvard 
teaching program of high quality in 
child psychiatry in this Hospital. 

George E. Gardner, Ph.D., M.D. 
Psychiatrist-in-Chief 



97 



PSYCHIATRIST-IN-CHIEF 



SERVICE STATISTICS 

October 1, 1961 - September 30, 1962 
Therapy session with patients 4,755 
Interviews with parents of 
patients 3,439 

PSYCHOLOGICAL EVALUATIONS 

(separate visits; each visit is at least 
one hour) 

MOPD 636 

WARDS: of which 17 were 

patients on a private 

fee level 348 

Adolescent Unit 172 

Out-Patients (on a private 

fee level) 138 

Psychiatry Clinic 105 

Children's Mission 26 

DIAGNOSTIC EVALUATIONS 

MOPD 

patients 904* 

parents 249 

Adolescent 
patients 69 

parents 40 

Seizure Unit 
patients 13 

parents 13 

Ward 

patients 101 

parents 

Endocrine 

patients 13 

parents 2 

Number of patients referred to 

the Psychiatry Department for 
the above service 1,417 

Average number of children seen 

in therapy during current year 215 
Average case load in intensive 

treatment at any one time 152 
*680 were Full Diagnostic Evaluations 



Publications 

Gardner, George E., "Personality De- 
velopment and Childhood Behavioral 
Disabilities," Chap. 10, pp. 161-195, 
in Norman Q. Brill ( Ed. ) , Psychiatry 
in Medicine. Berkeley and Los An- 
geles, University of California, 1962. 

Makkay, Elizabeth S., "Report on Re- 
search Studies" in "Summary of Pro- 
ceedings of In Service Conference 
on Exceptional Children." Eugene, 
Oregon: State Department of Educa- 
tion, 1961. (Ed.) L. P. Menlar. 

, "Behavioral and Educational 

Disabilities of Certain School-Age 
Children" in "Summary of Proceed- 
ings of In Service Conference on Ex- 
ceptional Children." Eugene, Ore- 
gon: State Department of Education, 
1961. 

, and Schwaab, E. H. "Some 



Problems in the Differential Diag- 
nosis of Antisocial Character Dis- 
orders in Early Latency." Journal of 
the Amercian Academy of Child 
Psychiatry, 1: 414-430, 1962. 

Coolidge, J. C, Tessman, E., Wald- 
fogel, S., and Wilier, M. L. Patterns 
of Aggression in School Phobia. The 
Psychoanalytic Study of the Child, 
17: 319-333, 1962. 

Kaufman, I., Frank T., Friend, J., 
Heims, J. W., and Weiss, R. Success 
and Failure in the Treatment of 
Childhood Schizophrenia, American 
Journal of Psychiatry, 118: 909-915, 
1962. 

Russell, Donald, The Massachusetts 
Court Clinic Program. Juvenile Court 
Judges Journal. 

Zilbach, Joan, Profile of a Socially De- 
prived Girl, pp. 5-34 in Girls in 
Crisis. Cleveland: Group Work 
Council and School of Applied So- 
cial Science. Western Reserve Uni- 
versity 1962. 

Blitzer, John R., Rollins, Nancy, and 
Blackwell, Amelia. "Children Who 
Starve Themselves, Anorexia Ner- 



vosa." Psychosomatic Medicine. Vol. 
XXIII, No. 5, September-October, 
1961. 

Wolff, Peter H., "Maternal Deprivation 
and the Concept of Time in Chil- 
dren." American Journal of Ortho- 
psychiatry. (Discussant) Vol. XXXI, 
No. 2, April, 1961. 

, "Children in the Hospital" 

(review of film) by Edward Mason, 
M.D. American J. of Public Health: 
October, 1962. 

-, 'Theoretical Problems of Early 



Development, Child Development 
Center, New York, 1961. 

Krims, Marvin Bennett, "Psychiatric 
Observations on Children with Pre- 
cocious Physical Development." 
American Academy of Child Psychi- 
atry, Vol. 1, No. 3, July, 1962. pp. 
397-413. 

Blaine, Graham Burt, "Patience and 
Fortitude: The Parents' Guide to 
Adolescence." Atlantic, Little-Brown, 
Boston: June 1962. 

Bullard, Dexter Means, The Family as 
a Potential Resource in the Rehabili- 
tation of the Chronic Schizophrenic 
Patient: A Study of 60 Patients and 
Their Families, with Anne S. Evans 
and Maida H. Solomon, The Am. J. 
of Psychiatry, Vol. 117; No. 12, 
June, 1961. 

Deutsch, Felix, "Mind, Body and Art." 
Daedalus, Journal of American 
Academy of Science, I960, pp. 34-45. 

, "Body, Mind and Sensory Gate- 
ways," Monograph. Basic Books Inc., 
N. Y. 1962. 

Waldfogel, Samuel, and Gardner, 
George E., "Intervention in Crises 
as a Method of Primary Prevention," 
Chap. XIv, pp. 307-322, in Gerald 
Caplan (Ed.), Prevention of Mental 
Disorders in Children: Initial Ex- 
plorations. New York: Basic Books, 
1961. 

Lennenberg, Eric. H, "Color naming, 
color recognition, color discrimina- 



98 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



tion, a reappraisal." Perceptual Motor 
Skills, 1961, 12: 375-382. 
, "A laboratory for speech re- 



search at The Children's Hospital 
Medical Center." N.E.J.M. 266: 385- 
392, 1962. 

"The relationship of language 



to the formation of concepts." Syn- 
these 14: 103-109, 1962. 

-, "Understanding language with- 



out ability to speak: a case report.' 
/. Abnor. and Soc. Psychol. 65: 419- 
425, 1962. 
, Book Reviews; 



Pittenger, R. E., Hockett, C. F., & 
Danehy, J. J., The First Five Min- 
utes. Language 38: January-March, 
1962. 

Luria, A. R. The role of speech in 
the regulation of normal and ab- 
normal behavior. Psychosomatic 
Med. March-April 1962, 219. 
Brosnahan, L. F. The sounds of lan- 
guage. Contemp. Psychol. 1962, 230- 
231. 

Bell, N. Trieschman, A., Vogel, E., "A 
Socio-cultural Analysis of the Resist- 
ances of Working-Class Fathers 
treated in a Child Psychiatric Clinic," 
American Journal of Orthopsychi- 
atry, Vol. XXI, 388-405, 1961. 

Cohen, H., "Psychological Test Find- 
ings in Adolescent Girls Having 
Ovarian Dysgenesis," Psychosomatic 
Medicine, Vol. 24, 250-256, 1962. 

Gair, D. S., Salomon, A. D., "Diagnos- 
tic Aspects of Psychiatric Hospital- 
ization of Children," American Jour- 
nal of Orthopsychiatry, VoL XXXII, 
445-461, 1962. 

Salomon, A. D, "Rehabilitation in a 
Domiciliary Program, Final Report 
on Special Project RD229*", U. S. 
Department of Health, Education 
and Welfare, Office of Vocational 
Rehabilitation, 47 pp., 1961. 
(•Project Coordinators: Count D. 
Gibson, Jr., M.D., and John J. Lo- 
rentz, M.D. ) 



Stone, J. L., Fiedler, M. F., Fine, C. G., 
"Preschool Education of Deaf Chil- 
dren," Journal of Speech and Hear- 
ing Disorders, Vol. 26, 47-60, 1961. 

Grunebaum, Margaret, Hurwitz, I., 
Prentice, N. M., and Sperry, Bessie 
M. Fathers of sons with primary 
neurotic learning inhibitions. Amer. 
J. Orthopsychiatry, 1962, 32, 462- 
472. 

Prentice, N. M., Ethnic attitudes, neu- 
roticism, and culture, /. Soc. Psychol., 
1961, 54, 75-82. 

Rosenwald, Richard, J., M. D., and 
Donald H. Russell, M. D, "Cough 
Syrup Addiction," NEJM 264:927, 
May 1961. 



99 



RADIOLOGIST-IN-CHIEF 



REPORT OF 
RADIOLOGIST-IN-CHIEF 

The period covered by this report has 
been a busy and productive one. Ex- 
aminations continue to increase in 
number and complexity. Equipment 
becomes obsolete and is replaced. Wet 
film development has given way to 
automatic processing, fluoroscopes to 
image amplifier systems, and cine and 
television presentations have become 
commonplace. Specialized equipment 
for neuroradiology is essential and 
other equipment of advanced design 
is used for the study of the cardiovas- 
cular system alone. The study of nor- 
mal and abnormal physiology has be- 
come as important as the examination 
of gross morphological changes. Few 
portions of the human body are beyond 
the reach of radiological investigations 
and in the Department during the last 
year certain studies on the anatomy 
and physiology of the Eustachian tube 
leading to the middle ear have been 
carried out successfully for the first 
time. 

Mr. Eric Hammond, Technical 
Assistant to the Department, has pro- 
vided leadership to the radiologists and 
to many industries in indicating and 
establishing trends in roentgen tech- 
niques so that very soon we may hope 
for even more definitive use of radiog- 
raphy under image system guidance 
that will yield diagnostic information 
with a minimum of roentgen dose. 
Even now the dose-information ratio 
that has been attained by Mr. Ham- 
mond's meticulous radiation surveys 
may be the lowest in the country. 

The assiduous teaching activities 
of the members of the Department 
continue so that we present or partici- 
pate in ten teaching hours each week. 
Postgraduate education in pediatric 
radiology for pediatricians and radiolo- 
gists has long been a pleasant activity. 
Interest in this specialty has become 
very great indeed during the past five 
years and many are recognizing it as 



the fundament of teaching, logically 
undertaken before the phenomenon of 
aging and degenerative disease is stud- 
ied. The demand on the radiologists' 
time for lectures outside of the city has 
shown no sign of diminishing. Lectures 
have been given in Florida, California, 
British Columbia, New Brunswick and 
elsewhere. Papers given in Canada and 
overseas have resulted in the small 
award of honorary membership in the 
Canadian Association of Radiologists, 
the Royal Society of Medicine and in 
the Faculty of Radiologists of Great 
Britain. One lecture, given before the 
staff of the Hospital for Sick Children 
in Paris, was attempted in the French 
language. This was not thought to be 
one of our great successes. With this 
lesson in mind, commentaries at meet- 
ings in Rome and Stockholm were de- 
livered in English. Lecture trips con- 
sume considerable time and much 
energy so that many enticing invita- 
tions have been reluctantly refused and 
these include invitations to act as visit- 
ing professor in New Zealand and 
Australia and trips to Central America, 
Brazil and Hawaii. 

During the past two years some 
twenty research projects have been un- 
derway in the Department. Some of 
these have aborted, others brought to 
satisfactory conclusions so that mem- 
bers of the Department were enabled 
to present five papers at the Tenth 
International Congress of Radiology in 
Montreal and three before the recent 
American Roentgen Ray Society, and 
perhaps even more useful as a teaching 
means, some of these talks have been 
accompanied by scientific exhibits and 
by refresher courses. It is hardly 
worthwhile enumerating all of the 
studies that have been carried out in 
the Department during the past two 
years, extending as they do from very 
small studies in New England folk 
medicine such as lycoperdonosis to the 



100 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



explanation of the etiology of pneu- 
monia in dysautonomia, to studies in 
the colon utilizing aerosol foams, and 
a whole group of studies carried out 
by the Division of Radiotherapy. 

The Division of Radiotherapy has 
been particularly active, not only in 
patient care, but in research. Particu- 
larly interesting has been the continued 
study of the potentiating effect of x- 
radiation and chemical agents being 
studied in conjunction with the Chil- 
dren's Cancer Research Foundation, as 
well as studies of the effect of x-radia- 
tion and charged particles on human 
tissue. So that he can bring back new 
strength and knowledge to this very 
rapidly expanding field, Dr. Giulio 
D'Angio, radiotherapist, will be given 
a year's leave of absence to work in 
the radiation laboratories in Berkeley, 
California. We will miss Dr. D'Angio 
and look forward anxiously to his re- 
turn, but are happy to report that Dr. 
Melvin Tefft will be carrying on as 
full-time radiotherapist during his 
absence. 

The Department of Radiology it- 
self never seems to be static. After 
more than fifteen years of service, Miss 
Winifred Campbell retires as Chief 
Technician to attempt the equally 
arduous role of lady of leisure. She 
gave faithful and loyal service and will 
be greatly missed. Intradepartmental 
reorganization is a continuing process 
in which we have no fundamental 
changes in philosophy to report, but 
all thirty-two members of the Depart- 
ment deserve our thanks and apprecia- 
tion. 

Edward B. D. Neuhauser, M.D. 
Radiologist-in-Chief 



House Staff 








Daniel J. Hanson, Jr. 


Resident 


7/1/61 - 


12/31/61 


Kevin G. Ryan 


Assistant Resident 


7/1/61 - 


12/3 1/61 


John F. O'Connor 


Assistant Resident 


7/1/61 - 


12/31/61 


Patricia A. McLellan 


Affiliating Assistant Resident 


7/1/61 - 


9/30/61 


Norman S. Williams 


Affiliating Assistant Resident 


10/1/61 - 


12/31/61 


Cesare Mazzucco 


Chief Resident 


10/1/61 - 


6/30/62 


Russell C. Briggs 


Resident 


1/1/62 - 


6/30/62 


James V. Roberts 


Assistant Resident 


1/1/62 - 


6/30/62 


Robert E. Gerth 


Assistant Resident 


1/1/62 - 


6/30/62 


Melvin Tefft 


Affiliating Assistant Resident 


1/1/62 - 


3/31/62 


Donald A. C Malcolm 


Affiliating Assistant Resident 


3/1/62 - 


5/31/62 


Brian P. OTrfalley 


Research Fellow - Radiotherapy 


7/1/61 - 


6/30/62 



101 



RADIOLOGIST-IN-CHIEF 



Statistics 

Period Ending September 30, 1962 
Diagnostic Patients 30,237 

Films 86,399 

X-ray Therapy Patients 3,049 

Period Ending September 30, 1961 
Diagnostic Patients 28,526 

Films 81,378 

X-ray Therapy Patients 2,728 



Publications 

D'Angio, G. J. Clinical and Biologic 
Studies of Actinomycin D and 
Roentgen Irradiation. Am. J. of 
Roentgenology, Radium Therapy 
and Nuclear Med. Vol. 87, 106-109, 
Jan. 1962. 

DAngio, G. J., Iannaccone, G. Spon- 
taneous Pneumothorax as a Compli- 
cation of Pulmonary Metastases in 
Malignant Tumors of Childhood. 
Am. J. of Roentgenology, Radium 
Therapy and Nuclear Med. Vol 86, 
1092-1102, Dec. 1961. 

Cohen, J., and D'Angio, G. J. Unusual 
Bone Tumors after Roentgen Ther- 
apy of Children; Two case Reports. 
Am. J. of Roentgenology, Radium 
Therapy and Nuclear Med. Vol. 86, 
505-512, Sept. 1961. 

Harris, G. B. C, and Wittenberg, M. 
H. Roentgen Features of Respira- 
tory Distress in Infants. Interna- 
tional Anesthesiology Clinics. Little 
Brown & Co. Vol. 1, Issue 1, 53-68, 
Aug. 1962. 

Crigler, J. F., Cohen, M. I., and Witten- 
borg, M. H. Systemic Disturbances 
in Relation to General Dantofacial 
Growth and Development in Chil- 
dren. Am. J. of Orthodontics. Vol. 
48, No. 1, 1-20, Jan. 1962. 

Neuhauser, E. B. D., and Kaufman, H. 
J. A. O. Kovalevski and the Neuren- 
tic Canal; A note on some Historical 
Inaccuracies. Proceedings of the 
Royal Society of Medicine, Section 
of Radiology, Vol. 34, 927-920, Nov. 
1961. 

Neuhauser, E. B. D. Pulmonary Hy- 
pertension in Infancy and Childhood. 
The Gordon Richards Memorial 
Lecture. /. of the Canadian Associa- 
tion of Radiologists. Vol. 12, Sept. 
1961. 



102 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



REPORT OF 
SURGEON-IN-CHIEF 



Like all other Services in the Hospi- 
tal, our activities can be divided into 
those of patient-care, teaching duties, 
and research. Some remarks are in 
order relevant to each of these. 

A review of statistics shows that 
over the last fifteen years our annual 
patient-load has had a general upward 
trend. Indeed, the number of opera- 
tions per year now is about double 
the figure of a decade ago. This ac- 
complishment is somewhat remark- 
able in view of the fact that other 
children's surgical services have opened 
up and developed in the Greater Bos- 
ton area, and that several additional 
men are devoting a large portion of 
their time to the practice of chil- 
dren's surgery in some of the general 
hospitals in and about Boston. It is 
obvious the various shifts which are 
occurring in the practice of our spe- 
cialty in the New England region 
necessarily bring about considerable 
change in the kind of material which 
is referred to our Institution. The 
more common and simple operative 
undertakings can now be done safely 
in many other hospitals, whereas the 
more desperate and complicated types 
of cases tend to be sent here. There 
can be no question that this trend will 
continue, and that it will be more 
emphasized in future years. 

In spite of the increasing com- 
plexity and seriousness of problems 
we must treat, the multiplicity of de- 
fects which some children possess, and 
the necessity for major surgery in 
many subjects who are premature 
(under five pounds), our total re- 
covery rate has been astoundingly 
high. Over the country, services in 
adult general surgery usually show an- 
nual mortality rates of 2.5 to 3.0 per 
cent or slightly higher; it is univer- 
sally recognized that mortality rates 
are always highest in groups of elderly 
people and of infants and children. 
We therefore look with considerable 



pride on the fact that for the year July 
1, 1961 through June 30, 1962, the 
total number of operations was 2,629, 
with a mortality rate of 2.16 per cent. 
This record is a great tribute to the 
diligence, skill, and supervision of our 
senior staff. Further, this could not 
have been accomplished without the 
superb group of House Officers we 
are fortunate to have, and it certainly 
could not have been brought about 
without the unceasing devotion of our 
dedicated nurses, who literally make 
the difference between life and death 
in many of the desperate struggles. 

One of the most gratifying parts 
of my job as Chief is receiving the in- 
numerable letters from parents — 
spontaneously written — concerning 
children who have been treated here. 
Some of these parents have lost a 
youngster, but even in their grief have 
taken the trouble to express apprecia- 
tion for what was given in the way 
of therapeutic help, kindly gestures, 
and sympathetic understanding. Fortu- 
nately, most of these letters come from 
mothers and fathers whose sons or 
daughters have survived successfully a 
surgical ordeal, and there is profound 
gratitude for what has been done by 
our doctors, House Officers, nursing 
service, and other Hospital personnel. 
This warmth of feeling represents 
great strength and solid backing for 
our Institution. 

The following is a monthly sum- 
mary of operations: 

OPERATIONS 

July 1, 1961 through June 30, 1962 

Private Staff Total 
1961 

July 115 110 225 

August 109 163 272 

September 85 100 185 

October 91 114 200 

November 111 114 225 

December 70 80 150 



103 



SURGEON-IN-CHIEF 



98 


114 


212 


93 


123 


216 


103 


116 


219 


99 


129 


228 


105 


134 


239 


122 


136 


258 



1962 

January 

February 

March 

April 

May 

June 

Total operations 1,201 1,428 2^29 

While our interests are broad in 
the general field of pediatric surgery, 
it might be well to point out some 
particular areas where, in the last few 
years, focusing upon a specific prob- 
lem has increased our knowledge of 
a disease, improved our technical 
maneuvers in therapy, and led to re- 
duced mortality and morbidity rates 
in handling the condition. 

Appendicitis in children is com- 
mon and is a serious threat to life. 
About half of the cases which come 
to us have already progressed to rup- 
ture and peritonitis. Yet there has 
been no mortality in the surgical care 
of these children; indeed, there has 
been no death from this condition in 
our Hospital during the last eighteen 
years. 

In the past, a large number of chil- 
dren were seen with recurring urinary 
infection, hydronephrosis, or other 
serious conditions of the urinary tract. 
Many of these were given alleviation 
for the complication which presented 
at the moment, but the primary or 
underlying defect was not recognized. 
It has now become evident that a high 
proportion of these patients have, as 
their primary trouble, a partial block- 
age at the outlet of the bladder, which 
brings on, secondarily, the other de- 
structive effects in the excretory tract 
above the bladder. Technical methods 
have now been devised to detect this 
obstruction of the bladder, and to re- 
lieve such blockage surgically. This 
is a tremendous advance in the un- 
derstanding and handling of a large 
number of urological problems which 



previously had baffled us. Already 
sixty such children have been brought 
to operation; this promises to be an 
excellent chapter in the advance of 
pediatric surgery. 

Patients who have the more com- 
plex cardiac abnormalities and who are 
supported by an artificial heart-lung 
machine for the longer periods of 
time (one to two hours) are apt to 
develop some degree of "acidosis," 
which is a considerable derangement 
of the acid-base balance of the body. 
A new drug, "tris," has been thor- 
oughly studied and has been found to 
be highly effective in relieving the 
acidosis promptly. This provides a 
very important addition to our arma- 
mentarium. 

Through the untiring efforts and 
great contributions of Dr. William E. 
Ladd, this Hospital has long been in- 
terested in the treatment of esophageal 
atresia (which is a congenital complete 
block in the tube which should carry 
food from the mouth to the stomach) . 
After a fatality rate of 100 per cent 
through the nineteen thirties, Dr. 
Ladd's first successful operative correc- 
tion of this condition (indeed, the first 
successful one in the world) came in 
1939. Following this, he made addi- 
tional studies and advances which put 
this corrective operation on a very 
sound footing. These dramatic steps 
have now added up to the point where 
we can look upon two hundred chil- 
dren who have survived these repairs 
in The Children's Hospital! This is 
truly a phenomenal record and far 
surpasses any comparable series in the 
world. While the repairs have been 
placed on a very sound basis for babies 
weighing above five or six pounds, it 
has been recognized that such exten- 
sive surgery in premature babies of 
three or four pounds still leads fre- 
quently to failure. Therefore, in the 
last few years, we have changed our 



approach and instead of attempting to 
make an immediate and total recon- 
struction in a tiny baby, we now 
"stage" it, performing a patt of the 
repair in the first days of life, then 
completing the whole repair a few 
weeks later. This "staging" has already 
shown recovery rates which are about 
twice as high as they formerly were 
for premature babies. 

In these times one hears and reads 
much in the medical and lay press con- 
cerning congenital anomalies in hu- 
mans. There can be no doubt that 
continued and intensified efforts should 
be made to prevent these conditions, 
or to minimize their incidence; doubt- 
less we will hear of advances in this 
direction. The fact remains that cur- 
rently there is a job to do in recon- 
structive surgery, to cure or alleviate 
such conditions appearing in babies 
which are troublesome or which are an 
actual threat to life. An indication of 
the magnitude of the problem is shown 
by the fact that last year more than 
1,000 patients were operated on for 
correction of some kind of congenital 
anomaly on our Service (obviously 
this figure would be further increased 
if we were to include material from 
the Orthopedic, Neurosurgical, and 
Otolaryngologic^ Services). 

One of the strongest segments of 
our general Surgical Service is the sec- 
tion on plastic surgery. Before the war, 
plastic procedures were performed here 
by literally a dozen different surgeons. 
Much of this was good, but it was 
often noted that for some conditions 
any one man was not able to build up 
enough material, judgment, and techni- 
cal skill to handle the condition in the 
best possible way. Therefore, when I 
took over the Service in 1947, it 
seemed highly desirable to have all of 
the staff (including myself) give up 
this work and concentrate it in the 
hands of a single surgeon who could 



104 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



intensify his interest and devote his 
whole time to it, thus building up a 
unified group of cases and permitting 
this man to develop unsurpassed au- 
thority and skill in plastic surgery. We 
feel that in designating Dr. Donald W. 
MacCollum for this job an excellent 
step forward has been made. Further, 
for twenty-five years he has conducted 
in our Out-Patient Department a 
weekly plastic clinic which is a model 
of excellence in its following of pa- 
tients, reporting to referring doctors, 
and giving supervision to a special 
group of cases. There has been no one, 
on any Service, who has been so faith- 
ful in personal attendance and man- 
agement of a clinic over a period of 
two and a half decades. I feel confident 
that babies and children requiring 
plastic surgery are getting top-flight 
service. Some idea of the extent of 
these activities can be gained by the 
following statistics, which are average 
figures per year, drawn from sum- 
maries of the last three years of work, 
indicating our Out-Patient clinic load 
and the in-patient operations. 

Patient visits in 

plastic clinic 1,637 per year 
Patient visits in Vermont 

clinic (which 

we run) 240 per year 

Patient visits, private 

office 1,900 per year 

Total patient 

visits 3,777 per year 

New cases (clinic 

and private) 628 per year 

Operations, various 
plastic 
procedures 388 per year 

Letters to doctors 
referring 
patients 2,385 per year 

We have been particularly inter- 
ested in building up our work in 



urology. There are a great many cases 
in this area in infancy and childhood. 
They include a fair number of young- 
sters with neoplasms, but most of the 
cases represent some congenital anom- 
aly of the urinary or reproductive 
tract, oftentimes with other sequellae 
(such as infection) grafted on the 
abnormality. The urological clinic in 
the Out-Patient Department has long 
been a busy unit, with various mem- 
bers of the staff working there. To 
give this a more permanent direction 
and controlled management, we have 
appointed Dr. Judson Randolph to be 
its chief. The quality of supervision 
in this clinic has vastly improved in 
the last few years, and I now feel we 
are offering children the very best care 
that is available in current urological 
therapy. 

We have been happy to unite with 
the urological training program of the 
Peter Bent Brigham Hospital, so that 
now, at all times, we have one of their 
Senior Residents with us on a full- 
time basis. This improves the coverage 
of our patients in this field, and simul- 
taneously provides a man in urological 
training with a body of pediatric 
material, such as is rarely available in 
other urologic training centers. 

In the last year there were 865 
visits to the out-patient urological 
clinic. Another estimated 870 visits 
were made in private offices of various 
surgeons in the Hospital, making a 
total of about 1,735 visits of a uro- 
logical nature. In the operating rooms 
there were a total of 95 cystoscopies 
and 338 urological operations per- 
formed during the year. Conditions 
operated upon were as follows: 

Undescended testis 69 

Hypospadias 50 

Bladder-neck obstructions 29 

Uretero-pelvic obstructions 1 I 

Exstrophy or epispadias 13 



Ileal conduit 


16 


Neoplasms 


25 


Sexual abnormality 


16 


Trauma 


4 


Torsion of testis 


5 


Ureteral reflux 


4 


Hydronephrosis 


9 


Double ureters 


7 


Uremia 


2 


Incontinence 


4 


Ureterocele 


2 


Cystic kidney 


10 


Urethral stricture 


14 


Phimosis 


19 


Bladder foreign body 


2 


Neurogenic bladder 


5 


Horseshoe kidney 


4 


Double urethra 


1 


Agenesis of testis 


2 


Meatal stenosis 


1 


Nephritis 


4 


Urethral fistula 


4 


Non-functioning kidney 


3 



Hypertension (nephrectomy) 1 
Urethral valves 1 

Urinary retention 1 

We can look with satisfaction on 
the several segments of our programs 
of training for students and doctors. 
We give second-year students a series 
of exercises designed as introductions 
to methods of physical examination, 
stressing the kind of pathological 
processes which are apt to be found in 
infancy and childhood. All third-year 
students in the Harvard Medical 
School come to this Hospital for a 
period of five to six weeks for teaching 
in pediatrics, including its manifold 
aspects. During this time, we give 
weekly conferences and demonstrations 
which allow us to lay before students 
the more common conditions which a 
surgeon must handle, stressing points 
relative to recognition and diagnosis, 
but only outlining the surgical steps in 
therapy, and summarizing the results 
which can be expected. For fourth- 
year students we have a voluntary 



105 



SURGEON-IN-CHIEF 



course, and each month through the 
year two men come to us and become 
an active part of the House Staff. Be- 
ing on constant duty for a month 
permits them to be exposed intimately 
to all activities within the Department. 
There is no better way to get a good 
introduction to surgery than by ad- 
mitting patients, helping at the oper- 
ating table during the surgical 
procedures, and taking a part of the 
responsibility for management of a 
child during the postoperative period. 
Students have been very enthusiastic 
about this course. 

Our House Staff consists of twelve 
men, arranged in a pyramidal order, 
with increasing responsibility as they 
ascend the pyramid. At the base of 
the pyramid are six Assistant Resi- 
dents, each of whom spends one year 
at The Children's Hospital as a part 
of a three-year combined appointment 
at the Peter Bent Brigham Hospital, 
West Roxbury Veterans Hospital, and 
The Children's Hospital. This has 
proved to be an extremely desirable 
way of giving a broad basis in surgery 
to young men. At the intermediate 
level in our pyramid are five Residents, 
each man being with us for two years, 
a new man coming on each six months. 
These men have all previously had at 
least three or four years of surgery 
elsewhere, and some of them have had 
more than this. They come from 
numerous academic centers around the 
country. These Residents have a high 
degree of responsibility and the ar- 
rangements are such that we have 
been able to provide them with an ex- 
cellent training during the period. At 
the apex of our House Staff training is 
a Chief Resident, who holds this post 
for one year. He is a man who has had 
six or seven years of surgery since 
graduation from medical school. I have 
nothing but the highest regard for 
these men. They are a superior group, 



taking full advantage of the educa- 
tional opportunities that we can offer, 
and obviously contributing greatly to 
the efficient and satisfactory running 
of our Hospital. 

In the area of research there has 
been an intense interest and activity 
in a number of subjects. Our research 
laboratory, modernized and enlarged a 
few years ago, has amply fulfilled our 
dreams for establishing such a unit. It 
is arranged and equipped in an excel- 
lent manner, and provides an ideal 
place for the study of a wide variety 
of questions, the solution of which 
will enhance our ability to handle the 
baffling surgical problems presented to 
us by babies and children in the Clinic. 
The laboratory is building up a sound 
financial backing from several outside 
sources, completely divorced from 
general Hospital funds. The staff is 
growing in a very satisf actory way. We 
can carry on research, not only in areas 
of cardiovascular interest, but can ex- 
tend activities to include a number of 
other areas of investigation which re- 
late to problems in general pediatric 
surgery. 

Because of widespread interest 
through the country in a recently- 
developed technique of resuscitating 
individuals who have had cardiac ar- 
rest by giving external repeated pres- 
sure on the anterior chest wall, a 
number of studies have been under- 
taken in the laboratory to measure the 
efficacy of this technique. It has been 
shown that the blood pressure can be 
maintained, and that there is a satis- 
factory distribution of blood through- 
out the body. Other measurements 
have been made which are of interest 
and importance to doctors, who might 
be called on at any moment to use this 
method of resuscitation. 

Looking toward the future, it is 
our hope to extend important observa- 
tions first made by Boerema of Holland 



that subjecting an animal or human 
to increased atmospheric pressure has 
certain very striking benefits, particu- 
larly when there is impairment of effi- 
ciency in the respiratory or circulatory 
apparatus. These observations open up 
a whole new vista of possibilities for 
giving temporary relief to those young- 
sters we see with advanced pulmonary 
or cardiac lesions, who have some hope 
of permanent survival if we can get 
them over their current crisis. In the 
entire world, there are only a half 
dozen large compression chambers, 
since these are extraordinarily compli- 
cated and are expensive to build. 
Fortunately, such a chamber exists in 
the adjacent building of the Harvard 
School of Public Health, and through a 
contractual agreement we were able to 
use this facility extensively for im- 
portant and medically profitable activi- 
ties. Increased demands on the chamber 
by the School of Public Health for 
other, equally-important research, how- 
ever, have led C. H. M. C. to take 
steps to acquire a facility of its own. 
Having unlimited access to a high 
compression chamber will give us an 
opportunity of great rarity and im- 
portance. Indeed, the observations and 
studies which have been made in the 
pressure chamber to date will un- 
doubtedly be of vast importance to us 
in the future handling of some of the 
desperate pulmonary and cardiac prob- 
lems which we often have to face in 
youngsters. 

The following is a list of recent 
publications from the Department 
which we look upon as work well 
done, well summed up, and published 
so that the benefits of our findings can 
be made readily available to other 
interested persons throughout the 
country. In addition to this bibli- 
ography of forty papers which have 
already appeared in print in the last 
two years, there are twenty others 



106 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



which have been submitted to various 
scientific journals and are in the proc- 
ess of publication. 

Robert E. Gross, M.D. 
Surgeon -in- Chief 



Publications 

Bering, E. A. Jr., Bernhard, W. F., 
Schwarz, H. F., and Sutton, C. H.: 
Vascular resistance and oxygen uti- 
lization of the brain, heart, and 
whole body in profound hypother- 
mia. Amer. College of Surgeons, 
Surgical Forum X77/411 & 412, 
1961. 
Bernhard, W. F., Schwarz, H. F., and 
Mallick, N. P. : Elective hypothermic 
cardiac arrest in normothermic ani- 
mals. Ann. Surg., 153:43-51, 1961. 
Bernhard, W. F, Schwarz, H., and 
Mallick, N. P.: Profound hypother- 
mia as an adjunct to cardiovascular 
surgery. /. Thoracic & Cardiovascu- 
lar Surg., 42/263-274, 1961. 
Bernhard, W. F., Schwarz, H. F, Hug, 
G., Carroll, E., and Jokins, H.: Altera- 
tions in myocardial metabolism sub- 
sequent to hypoxic and hypother- 
mic cardiac arrest. Amer. College 
of Surgeons, Surgical Forum XII: 
171-173, 1961. 
Bernhard, W. F., and Grass, A. M.: 
A method for localizing of the car- 
diac conduction system during open- 
heart surgery. New England J. Med., 
26.5/1079-1083, 1961. 
Bernhard, W. F., Schwarz, H. F., Leand, 
P. M., and Carr, J. G.: Studies in 
balanced hypothermic perfusion. 
Surgery .50/911-918, 1961. 
Bernhard, W. F., Malcolm, J. A., and 
Wylie, R. H.: The carcinomatous 
abscess: A clinical paradox. New 
England J. Med., 266/919, 1962. 
Editorial page 949. 
Bernhard, W. F., Carroll, S. E., Schwarz, 
H. F., and Gross, R. E.: Metabolic 
alterations associated with profound 
hypothermia and extracorporeal cir- 
culation in the dog and man. /. 
Thoracic and Cardiovascular Surg., 
42/793-803, & 825-830, 1961. 
Bernhard, W. F., and Gross, R. E.: 
The rationale of hypothermic cardio- 
plegia in the management of con- 



genital anomalies affecting the aor- 
tic valve, coronary arteries and prox- 
imal aortic arch. Ann. Surg. 156: 
161-172, 1962. 

Bernhard, W. F., Moore, D., and Gross, 
R. E.: The management of meta- 
bolic lacticacidosis accompanying 
prolonged hypothermic perfusion. 
Proceedings of the New England 
Cardiovascular Society, XX:46 & 47, 
1961-1962. 

Bernhard, W. F., and Gross, R. E.: 
Extracorporeal circulation and pro- 
found hypothermia: A new surgical 
technique. Proceedings of the New 
England Cardiovascular Society, 
XIX.-ll & 12, 1960-1961. 

Brief, D. K., and Gross, R. E.: A new 
chest tube for use in open heart 
surgery. /. Thoracic & Cardiovas- 
cular Surg., 43/408-409, 1962. 

Deconomopoulos, C. T., and Chamber- 
lain: Torsion of the appendix testis 
with observations as to its etiology. 
An analysis of 26 cases. Pediatrics, 
26/611-615, 1960. 

Gross, R. E., Schwarz, H. F., Mallick, 
N. P.: Arbeit unter der leitung con 
Bernhard, W. F., Throaxchirurg, 
Boston. Herzstillstand durch kalte 
coronarperfusion in normal warmen 
tier. Swiss J. Med. 92/447, 1961. 

Gross, R. E.: Atrial septal defects of 
the secundum type. Progress in Car- 
diovascular Disease 77/301-311, 
1962. 

Gross, R. E.: I difetti del setto inter - 
atriale del tipo ostium secundum. 
Progressi in Pathologia Cardiovasco- 
lare, 7/117-128, March-April, 1962. 

Hill, G. F., and Longino, L. A.: Giant 
hemangioma with thrombocytopenia. 
Surg. Gynec, & Obst.. 774/304-312, 
1962. 

Laforet, E. G, Parton, C W., and 
Starkey, G. W. B.: Morgagni hernia 
containing liver: Operative manage- 
ment in two children. Boston Medi- 
cal Quarterly. Boston University 



107 



SURGEON-IN-CHIEF 



School of Medicine and Mass. Me- 
morial Hospitals, 13:1962. 

Laforet, E. G., Starkey, G. W. B., and 
SchefF, S.: Anomalies of upper lobe 
bronchial distribution. /. Thoracic 
and Cardiovascular Surg., 43:595- 
606, 1962. 

Lees, M. H., Hauck, A. J., Starkey, 
G. W. B, Nadas, A. S, and Gross, 
R. E.: Congenital aortic stenosis op- 
erative indications and surgical re- 
sults. British Heart J. XX/F/31-38, 
1962. 

Longino, L. A., Hendren, Hardy, III., 
and Owings, R. S.: Congenital hy- 
pertrophic pyloric stenosis. Amer. 
J. Surg., 101:605-609, 1961. 

Longino, L. A., and Hill, G. J. II: Giant 
hemangioma with thrombocyto- 
penia. Surg., Gyn., & Obst., 114:304- 
312, 1962. 

Mansfield, P. B.: An apparatus for 
elective fibrillatory cardiac arrest in 
experimental and clinical cardio- 
pulmonary bypass operations. /. 
Thoracic & Cardiovascular Surg., 
43/402-405, 1962. 

Martin, L W., and MacCollum, D. W.: 
Hemangiomas in infants and chil- 
dren. Amer. J. Surg., 101:571-580, 
1961. 

Moore, A. A. D., Bernhard, W. F., and 
Kevy, S. V.: The efficacy of 2-Amino- 
2-hydroxymethyl-l, 3 propanedial 
in the restoration of heparinized 
blood. Clinical Research, X/203, 
1962. 

Nadas, A. S., Van der Hauwaert, L., 
Hauck, A. J., and Gross, R. E.: Com- 
bined aortic and pulmonic stenosis. 
Circulation, XXJ//346-355, 1962. 

Osborn, J. J., Cohn, K., Hait, M., Russi, 
M., SabeL A., Harkins, G., and Ger- 
bode, F.: Hemolysis during perfu- 
sion. Sources and means of reduc- 
tion. /. Thoracic and Cardiovascu- 
lar Surg., 43A59-464, 1962. 

Randolph, J. G: On the Treatment of 



Lymphangioma in children. Surgery 
49:289-290, 1961. 

Randolph, J. G.: Pediatric surgery 
Chapter 23 in Surgery, A Concise 
Guide to Clinical Practice. Nardi, 
G. L., and Zuidema, G. D. Little 
Brown and Company, Boston, 1961. 

Randolph, J. G, and Handler, A. H: 
Response of the canine host to 
transplanted human melanoma. Fed. 
Proc, 21:40, 1962. 

Redo, S. F., Farber, S., and Gross, R. E. : 
Atresia of the mitral valve. Arch. 
Surg., 82:696-712, 1961. 

Replogle, R. L., and Gross, R. E.: Renal 
function during extracorporeal cir- 
culation. /. Surg. Research, 1/91-96, 
1961. 

Sauvage, L. R., Gross, R. E., Rudolph, 
A. M., Pontius, R. G., and Watkins, 
E., Jr.: An experimental study of 
tissue and prosthetic grafts with 
selected application to clinical intra- 
cardiac surgery. Ann. Surg., 153: 
321-343, 1961. 

Schuster, S. R., and Gross, R. E.: Sur- 
gery for coarctation of the aorta: 
A Review of 500 cases. /. Thoracic 
& Cardiovascular Surg., 43:54-70, 
1962. 

Schuster, S. R., and Gross, R E.: Sur- 
gical treatment of aortic coarctation. 
Modern Medicine 30/101-103, 1962. 

Schuster, S. R., Gross, R. E., and Co- 
lodny, A. H.: Surgical management 
of anomalous right pulmonary 
drainage to the superior vena cava, 
associated with superior marginal 
defect of the atrial septum. Surgery, 
51. -805-808, 1962. 

Schwarz, H. F., and Gross, R. E.: Tiefe 
hypothermic in der behandlung con- 
genitaler herzfehler. Helvetica 
Chirurgica Acta, Switzerland 29: 
405-417, 1962. 

Scott, L. P., Lt. Comdr, MC USN., 
Hauck, A. J., Nadas, A. S., and 
Gross, R. E.: Endocardial cushion 



defect. Preoperative and postopera- 
tive survey. Circulation, XXVI:218- 
227, 1962. 

Smith, E. I., and Gross, R. E.: The 
external sphincter in cases of im- 
perforate anus: A Pathologic study. 
Surgery, 49/807-812, 1961. 

Starkey, G. W. B., and Abelmann, W. 
H: Isolated stenosis of the pulmonic 
valve associated with pulmonary 
tuberculosis. 7- Thoracic and Cardi- 
ovascular Surg., 42/158-167, 1961. 



108 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



REPORT OF 
ANESTHESIOLOGIST-IN-CHIEF 



During the past year the Anesthesia 
Department has continued to consider 
better patient care as its principal aim. 
To attain this, however, has entailed a 
much more diversified approach than 
heretofore, since it has included not 
only development of improved clinical 
techniques, wider teaching activities, 
and more active investigation, but has 
also included reorganization of the De- 
partment atid its establishment as an 
independently functioning unit. The 
latter steps, through development of 
greater strength at the top and more 
sound organization, will provide better 
medical care as well as greater func- 
tioning efficiency as an economic unit. 

Personnel 

Due to the ever-increasing number of 
exacting operations that are under- 
taken at this Hospital, it has been 
necessary to increase the number of 
full-time physician anesthesiologists. 
At present our clinical, teaching, and 
administrative responsibilities are 
shared by four anesthesiologists, who 
show the following record: 

Joined Board 
C.H.M.C. Certified 
Robert M. 

Smith, M.D. 1/1/46 1951 
John B. 

Stetson, M.D. 7/1/59 I960 
John G. 

Adams, M.D. 10/1/61 1961 
Dean 

Crocker, M.D. 7/1/62 

The Anesthesia Department is 
now running on the policy whereby 
at least one of the above senior Staff 
men is on duty in the Hospital at all 
times of the day and night, thus insur- 
ing the best possible coverage for pa- 
tients and surgeons. 

Nurse anesthetists have always 
played an important role in this Hospi- 
tal, and although their number has 
decreased, their value is still great. At 



present Miss Betty Lank, with twenty- 
eight years of consistent service, and 
Mrs. Patricia Jackson contribute signifi- 
cantly to the efficiency of the Depart- 
ment. It is hoped that more nurse 
anesthetists of their caliber can be 
added to our staff. 

Residents and graduate Fellows 
have been trained in our Department 
for the past fifteen years. Most of the 
Residents come for periods of three or 
four months on a regular rotation dur- 
ing two- or three-year training pro- 
grams at the Peter Bent Brigham Hos- 
pital, Lahey Clinic, Massachusetts Gen- 
eral Hospital, Massachusetts Memorial 
Hospitals, U. S. Naval Hospital at 
Chelsea, and the Jackson Memorial 
Hospital in Miami, Florida. In addi- 
tion, other hospitals send men at 
chosen intervals. Graduate Fellows 
spend six months to one year at this 
Hospital following completion of their 
regular residency. To date over 300 
Residents and Fellows have received 
training in pediatric anesthesia in our 
Department. Due to teaching facilities 
and the excellent cooperation of the 
Surgical Service, the opportunities for 
experience in all types of anesthesia 
for children are unique. 

Clinical Activity 

The number of anesdietics adminis- 
tered during 1961 was 5226. This 
figure has undergone remarkably little 
change during the past several years, 
reflecting the relatively unchanging 
state of the total Hospital census. The 
surgical procedutes for which anesthe- 
sia is required have undergone con- 
siderable change, however, of both 
evolutionary and revolutionary nature. 
It has been inevitable that procedures 
once performed only in this Hospital 
would be adopted elsewhete in gradu- 
ally increasing numbers. This has oc- 
curred in many categories of surgery, 
narrowing our work down until it 



109 



ANESTHESIOLOGIST-IN-CHIEF 



becomes limited to the more difficult 
cases in each category. The resulting 
loss is compensated for only by intro- 
duction of other surgical advances. In 
general, the trend has been to see more 
patients with complex lesions and to 
attack problems earlier in infancy, 
borh of which create added concern 
for the anesthetist. The revolutionary 
changes that have occurred have been 
related largely to the field of open- 
heart operations. This type of surgery 
has naturally offered a challenge to the 
anesthetist, and confronted him with 
new demands in relation to minimal 
depression of an over-burdened heart 
and proper methods of respiratory sup- 
port during and after operation. 

In an effort to keep pace with our 
ambitious surgeons we have been con- 
cerned in development of better 
anesthetic agents and apparatus; in 
methods of safeguarding and support- 
ing patients during operation, espe- 
cially in the ptevention and treatment 
of shock; and in assisting postoperative 
recovery. In the field of new anesthetic 
agents two drugs, halothane and me- 
thoxyfiurane, have gained acceptance 
in adult anesthesia due to their non- 
explosive and less irritating qualities, 
and we are investigating their use in 
infants and children. 

For greater safety during pediatric 
anesthesia the continual use of a 
stethoscope, specially constructed blood 
pressure apparatus, and a constant 
recording thermometer has become 
standardized and has been found to 
be of surprisingly great importance. 

In the event of operative hemor- 
rhage, greater survival has resulted 
from combined use of special blood 
pumping apparatus and freshly pre- 
pared blood, which has been warmed 
prior to administration, the addition 
of calcium, and in some instances an 
organic buffering agent tris ( hydroxy- 
methyl)aminomethane (tris buffer). 



During the past year considerable 
attention has been placed in the field 
of oxygen therapy and respiratory as- 
sistance. Increasing use of mechanical 
ventilating devices has necessitated 
organization of this form of therapy, 
and we have been fortunate in secur- 
ing the services of an experienced 
nurse, Miss Evelyn Cassara, who has 
accomplished much in a relatively 
short time. In addition to caring for 
surgical patients, consultant and thera- 
peutic services are rendered and resus- 
citation taught throughout the Hospi- 
tal. 

A formal program of laboratory 
investigation still awaits better build- 
ing facilities. In the meantime, re- 
search is carried on at a clinical level. 
It is hoped that greater facilities will 
soon be available. 

In an effort to contribute to the 
teaching of pediatric anesthesia, mem- 
bers of the staff have recently made 
four trips to Europe and South 
America, and have lectured in twenty- 
five cities in North America. 

Robert M. Smith, M.D. 

Anesthesiologist-in-Chief 



Publications 

Adams, J. G., Anesthesia for pediatric 
out-patients, International Clinics of 
Anesthesiology, Vol. 1, No. 1, Bos- 
ton, Little Brown & Co., 1962. 

Crocker, D., Clinical management of 
therapeutic hypothermia, Interna- 
tional Clinics of Anesthesiology, Vol. 
1, No. 1, Boston, Little Brown & Co., 
1962. 

Engineer, E. H., Tracheostomy in 
children — indications, anesthetic 
management and complications, In- 
ternational Clinics of Anesthesiology, 
Vol. 1, No. 1, Boston, Little Brown 
& Co, 1962. 

Gaviotaki, A, and Smith, R. M, Use 
of atropine in pediatric anesthesia, 
International Clinics of Anesthesiol- 
ogy, Vol. 1, No. 1, Boston, Little 
Brown & Co, 1962. 

Psaltopoulo-Mehrez, M, Anesthetic 
management of infants, International 
Clinics of Anesthesiology, Vol. 1, 
No. 1, Boston, Little Brown & Co, 
1962. 

Smith, R. M, and Engineer, E. H, 
Problems related to open-heart oper- 
ations in children. Part I, Anesthesia 
and Analgesia 39/109-109; Part II: 
ibid, 39:267-172, I960. 

Smith, R. M, Anesthesia for emer- 
gency surgery in children. Proc. 
Royal Soc. Med. 54:113-114, 1961. 

Smith, R. M, Preparing children for 
anesthesia and surgery. Am. J. Dis. 
Child 101:650-653, 1961. 

Smith, R. M, Stetson, J. B, and San- 
chez-Salazar, A, Postoperative dis- 
tress in children (Abstract). Anes- 
thesiology 22:145, 1961. 

Smith, R. M, and Stetson, J. B, The 
use of phenazocine (Prinadol) as 
an adjunct in pediatric anesthesia. 
Can. Anaes. Soc. }., 8:575-580, 1961. 

Smith, R. M, and Stetson, J. B, Thera- 
peutic Hypothermia, Review. New 
England J. Med. 265:1097-1103 & 
1147-1151, 1961. 



no 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Smith, R. M., Inhalational therapy in 
pediatrics, Anesthesiology 23:548- 
559, 1962. 

Smith, R. M., Anesthesia in Pediatric 
Surgery, edited by C. D. Benson, et 
al., Chicago: Year Book Publishers, 
Inc., 1962. 

Pediatric Anesthesia, R. M. Smith, Edi- 
tor, International Clinics of Anes- 
thesiology, Vol. 1, No. 1, Boston, 
Little Brown & Co., 1962. 

Smith, R. M., Signs of depth and 
danger, International Clinics of An- 
esthesiology, Vol. 1, No. 1, Boston, 
Little Brown & Co., 1962. 

Smith, R. M., Monitoring methods in 
pediatric anesthesia, Abstracts of 
First European Congress of Anes- 
thesiology, Vienna, September 1962. 

Smith, R. M., Regularly bimonthly edi- 
torial comments on abstracted pa- 
pers — Survey of Anesthesiology. 

Stetson, J. B., The pediatric airway, In- 
ternational Clinics of Anesthesiology, 
Vol. 1, No. 1, Boston, Little Brown 
& Co, 1962. 

Stetson, J. B, The Humane Societies 
& Resuscitation; Newton-Wellesley 
Hospital Medical Bulletin 8/1, 1961. 

Stetson, J. B, and Jessup, G. V. S, The 
use of oral chloral hydrate mixtures 
for pediatric premedication, Anes. 
and Anal, 47:203,1962. 

Stetson, J. B, Tax concessions would 
attract more medical students, New 
Medical Material, June 1961, p.55. 

Stetson, J. B, The first endotracheal 
intubation, Brit. ]. Anesthes. 33:227, 
1961. 



Ill 



DENTIST-IN-CHIEF 



REPORT OF 
DENTIST-IN-CHIEF 



The clinical activities of this Depart- 
ment have continued at peak capacity. 
The total number of out-patient visits 
exceeds 10,000. House patients served, 
including 150 strictly dental admis- 
sions of 48 hours or more, number 
175. About 300 patients requiring 
general anesthesia for dental extrac- 
tions have been served in the Surgical 
Out-Patient Department. The cour- 
tesy of the staff of that Department 
and the superb service and cooperation 
of the Department of Anesthesiology 
makes possible this needed service to 
the community. Consultations re- 
quested by other Departments of the 
Hospital exceed 125, and approxi- 
mately 50 patients have been referred 
from outside practitioners and other 
community hospitals for diagnosis 
and plan of treatment. "Off" hour 
emergency care of casual patients at 
night and on weekends is rapidly in- 
creasing to the point of becoming 
burdensome; these patients numbered 
more than 150 this past year. In our 
opinion, this is a reflection of the 
general community need of increased 
dental services, emphasizing the prob- 
lem of our eventual place in the 
community as a service unit. 

Special clinical services such as 
care to handicapped children unable 
to receive routine chair service in out- 
side practices because of crippling 
diseases continues to be a major obli- 
gation of this Department. 

One of the most important of 
our special responsibilities is the care 
and guidance of patients sustaining 
cleft palate. There are now approxi- 
mately 150 to 175 cleft palate patients 
receiving treatment and another 200 
under observation with treatment car- 
ried out elsewhere but supervised by 
the Dental Department. Under the 
attention of Dr. Lennard Swanson, 
plans for improved service for these 
patients as well as vastly needed re- 



search into the problem are hope- 
fully reaching fruition. 

Our greatest pleasure in being a 
part of a large general hospital for 
children is the splendid teaching ma- 
terial which is constantly available. 
With two interns, four postdoctoral 
students in part-time attendance 
throughout the year, and one pre- 
doctoral student throughout the 
academic year from the Harvard 
School of Dental Medicine, our con- 
stant annual need for new clinical 
material, as well as long-term patients, 
is adequately met by our present or- 
ganization. We take pride in our 
teaching privileges and appreciate the 
opportunities afforded. 

We hope and believe the "each 
one, teach one" principle of educa- 
tion reaches the doctors in training 
in other Departments as well as the 
student nurses and other trainees in 
allied health fields. One of the most 
satisfying efforts of our teaching 
privilege is the short course offered 
the postgraduate students in pediatrics 
from Harvard Medical School. Our 
Staff has also met the normal demand 
this year for "refresher" clinics to 
professional groups as well as essays 
and contributions to the dental litera- 
ture. 

The continuing need for increased 
research activities is annoying because 
of our ineffectiveness. Procurement 
and financing of adequate personnel 
is the chief barrier. Financing of spe- 
cific problems would probably not be 
too difficult if the salaries of profes- 
sional personnel were not dependent 
on income from clinical services. We 
hope for some help soon on this 
problem. 

Our present research interests are 
centered on regulatory care of cleft 
palate patients, relation of dental 
development and facial growth, en- 
vironmental dietary control of dental 
decay, and electrophoretic investiga- 



112 

REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



tions of human saliva — a paltry effort 
compared to the opportunity. 

With pride and regret we record 
the leaving of Dr. Charles Boyers from 
our senior professional Staff. He has 
gone to Buffalo to serve as Professor 
of Pedodontics at the University and 
to become Chief of Dental Services 
at the Children's Hospital there. Dr. 
Boyers was replaced by Dr. Terrence 
Hoover. Dr. Robert Watton, a gradu- 
ate of our service in 1961, has con- 
tinued his education at Tufts and will 
rejoin us next spring. 

Finally, I would like to point out 
the need of increased support for our 
teaching and research efforts. To 
repeat, we have a real need of out- 
side support for development of re- 
search personnel. If this effort is suc- 
cessful, we will have more need for 
laboratory space, and I feel sure the 
Planning Committee will show confi- 
dence in our development and assign 
us space in the projected new labora- 
tory and out-patient building. Dental 
disease is by and large prosaic and 
unromantic and therefore has little 
appeal for fund raising, but any ill- 
ness which causes the discomfort and 
economic waste that this disease does 
deserves the attention of all public 
welfare -minded people. We are 
frankly suggesting that a good invest- 
ment in medico-social needs can be 
made in the Dental Department at 
The Children's Hospital Medical 
Center. 

Paul K. Losch, D.D.S. 
Dentist-in-Chief 



113 

OPHTHALMOLOGIST-IN-CHIEF 



REPORT OF 
OPHTHALMOLOGIST- 
IN-CHIEF 

During the past year, efforts have been 
made to reorganize the Department. It 
is hoped eventually that this Depart- 
ment will play an important role in 
the Harvard Medical Center. The 
Massachusetts Eye and Ear Infirmary 
under its new chief, Dr. David Cogan, 
has agreed to rotate a Resident through 
The Children's Hospital Ophthalmol- 
ogy Department. This Resident rota- 
tion plan may not be available for 
several months, and an ad hoc com- 
mittee has been appointed to make 
recommendations for the reorganiza- 
tion of the Department. The present 
members of the Department are 
endeavoring to assist this committee. 
It is realized by all that such a reor- 
ganization must include plans for the 
sharing of expensive equipment and 
diagnostic facilities and even personnel 
with other members of the Harvard 
Medical Center. We would welcome 
the suggestions and the support of our 
colleagues in other Departments of 
The Children's Hospital Medical Cen- 
ter. 

Trygve Gundersen, M.D. 

Ophthalmologist-in-Chief 



114 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



REPORT OF 
OTOLARYNGOLOGIST. 
IN-CHIEF 

The activities of this Department have 
continued much the same as in the 
past. We are hampered by the same 
lack of facilities which confronts the 
other Services and have similar prob- 
lems in our Out-Patient Department 
as well as in the affiliated Hearing and 
Speech Clinic. Improvement of our 
Out-Patient Clinic is essential if we 
are to keep pace with the plans for 
generally augmenting the Hospital's 
Out-Patient services. It is reassuring to 
know that our needs are being taken 
into consideration by the planning 
committee and that these deficiencies 
will be remedied when new construc- 
tion is undertaken. 

We have made a real effort to in- 
crease the use of our beds, but there 
are certain inescapable difficulties, one 
of which is the seasonal nature of 
much of our work, which leads to an un- 
evenness in Hospital admissions. Usu- 
ally, from the middle of August to the 
latter part of October the Service is 
slow. After this time, as respiratory 
infections become increasingly preva- 
lent, the Service can be very busy. 
During the past winter our three high 
humidity croup rooms were in con- 
stant use on many occasions, and on 
several there were two patients in each 
room, so great was the demand. These 
rooms are special purpose areas and 
are not really suitable for general use. 
However, although we use them only 
six or seven months a year, they are 
absolutely indispensable in the care of 
patients with severe respiratory infec- 
tions, laryngeal obstruction, and after 
bronchoscopy or tracheotomy. This is 
one of the numerous small reasons why 
running a Hospital of this kind is such 
an expensive proposition. 

The resident training program 
with the Massachusetts Eye and Ear 
Infirmary continues to function well. 
The maturity and high professional 
quality of the young men participat- 



ing in this program reflects great credit 
on their parent institution. We cer- 
tainly hope our affiliation will continue 
to prosper. Dr. Sydney Shore, who is 
Chief of the Otolaryngology Service at 
Peter Bent Brigham Hospital, has re- 
cently been made a member of our 
staff. 

HEARING AND SPEECH CLINIC 
Since July of 1962 this Clinic has been 
under the direction of Dr. Allan C. 
Goodman, formerly of Washington 
University, St. Louis, Missouri. Dr. 
Goodman's former position was that of 
Assistant Professor of Audiology in 
the Department of Otolaryngology. He 
has had wide experience in the field 
of hearing and speech problems and a 
special interest in the hearing appa- 
ratus in relation to neurological dis- 
orders. In November of 1962 Dr. 
Goodman spoke before the American 
Speech and Hearing Association on 
"Audiological Signs of Intracranial 
Lesions." Miss Lois H. Averell, Speech 
Pathologist, resigned in order to con- 
tinue her doctoral studies at Boston 
University on a full-time basis. 

The Sarah Fuller program contin- 
ues to function at capacity. There are 
now forty-five pre-school children, all 
with severe degrees of deafness, receiv- 
ing instruction by highly qualified 
teachers. We have a waiting list for 
this program, partly because of the 
inadequacy of our present quarters. 
The Hearing and Speech Clinic is one 
of the most congested areas in the 
Hospital and is badly in need of new 
quarters. 

Carlyle G. Flake, M.D. 
Otolaryngologist-in-Cbief 



115 



OTOLARYNGOLOGIST-IN-CHIEF 



Publications 

Ferguson, C. F., and Flake, C. G., Sub- 
glottic hemangioma as a cause of 
respiratory obstruction in infants, 
Annals Otol., Rbinol., and Laryngol., 
70/1095, 1961. 

Guest editor, "Ear, Nose and 

Throat Problems," Pediatric Clinics 
of North America, Nov., 1962. 

Flake, C. G., Oliver, P., Richardson, J. 
R., Clubb, R. W., Tracheotomy in 
Children, New Eng. Jour. Med. 267: 
631, 1962. 

, Schwachman, H., Kulczycki, 

L. L., Mueller, H. L., Nasal polyposis 
in patients with cystic fibrosis, Pedi- 
atrics, 30:389, 1962. 



116 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



REPORT OF CHAIRMAN, 
STAFF PLANNING 
COMMITTEE 

A new vitality, which can be felt 
throughout The Children's Hospital 
Medical Center since the appointment 
by the President of the Board of 
Trustees, William W. Wolbach, of 
Dr. Leonard W. Cronkhite, Jr., as 
General Director, is recognizable also 
in the deliberations of the Staff Plan- 
ning Committee. Plans born of the 
accomplishments and dreams of mem- 
bers of the Staff, which have lost luster 
during recent years of inactivity as a 
consequence of concern with causes 
and remedies of Hospital deficits, have 
taken on fresh color. The eight Chiefs 
of Staff of The Children's Hospital 
Medical Center constitute the Plan- 
ning Committee, which has had con- 
tinuity in one form or another since 
1931. The present members are Drs. 
Randolph K. Byers, George E. Gard- 
ner, William T. Green, Robert E. 
Gross, Charles A. Janeway, Donald 
M. Matson, Edward B. D. Neuhauser, 
and the Chairman. The General Di- 
rector is an ex officio member and 
serves as Secretary. 

In a previous publication, the 
Planning Committee described The 
Children's Hospital Medical Center 
in the following words: 

"The plan that created The Chil- 
dren's Medical Center called for the 
gathering together, within one organ- 
ization, of all aspects of Medicine, 
Surgery and the Laboratory Sciences 
that concern themselves with the nor- 
mal and the sick infant, child, and 
adolescent. The pattern of centraliza- 
tion, encompassing a flexibility in the 
manner of merger or affiliation, has 
permitted institutions interested in 
children to join together and, in so 
doing, not only create a great medical 
center but strengthen themselves. Some 
developments in this direction have 
exceeded all expectations in the di- 
mensions of the programs achieved 
— for example, the Judge Baker Guid- 
ance Center and the Children's Can- 



cer Research Foundation. These two 
institutions and the Children's Mission 
to Children, which is concerned with 
social aspects of child care, are in- 
dependent corporations affiliated with 
The Children's Hospital, the Infants' 
Hospital, and other units comprising 
the more unified administrative struc- 
ture known as The Children's Hos- 
pital Medical Center. 

"This C. H. M. C. structure con- 
rains the facilities for bed care and 
most of the ambulatory services, and 
it houses the Departments of Radiol- 
ogy and Pathology, the Laboratories of 
Clinical Pathology, and most of the 
research activities of the clinical de- 
partments. Harvard Medical School 
carries out the major part of its pedi- 
atric teaching function in The Chil- 
dren's Hospital or through the Hos- 
pital's affiliates. There are also close 
relations — physical, spiritual, and in- 
tellectual — with the Peter Bent Brig- 
ham Hospital, which is connected with 
The Children's Hospital by a bridge 
over Shattuck Street. A similar bridge 
joins the Hospital with the Children's 
Cancer Research Foundation, which in 
turn connects through a door with The 
House of the Good Samaritan. The 
Judge Baker Guidance Center is joined 
to the Hospital by a tunnel." 

In the 1959 Planning Commit- 
tee Development Program, for the ten- 
year period to end with the One- 
Hundredth Anniversary of the Hos- 
pital in 1969, three priorities were 
delineated: 

Ambulatory Services 

The ambulatory services were selected 
as a priority of greatest importance, in 
recognition of the consistently increas- 
ing contribution to the care of children, 
as well as to teaching and research, 
which is made by the Out-Patient De- 
partment. The Committee, therefore, 
recommended the building of new 
physical facilities for ambulatory serv- 



117 



CHAIRMAN, STAFF PLANNING COMMITTEE 



ices, nor only to provide far better care 
for the sreadily increasing numbers of 
children and adolescents who require 
such services, but also ro permit the ex- 
tension of the horizons of clinical re- 
search, medical education, and post- 
graduate Training. We are delighted 
that in the first series of plans now be- 
ing completed, proper provision is 
made for these vital services. 

Clinical Research Facilities 

Long before the enormous and, to many 
people, completely unexpected growth 
of support of medical research through- 
out the country by the Congressional 
Appropriations to the National Insti- 
tutes of Health, the Planning Com- 
mittee oulined the possibilities for im- 
portant contributions to the care of 
the patient and to the prevention and 
eradication of disease that could be 
made in The Children's Hospital, and 
later in its Medical Center, if adequate 
facilities for both basic research and 
clinical investigation could be created. 
Great changes have indeed been made 
in many parts of our Hospital enter- 
prise with first priority properly given 
to the creation of better clinical facili- 
ties. The greatest laboratory develop- 
ment has taken place in our affiliated 
Children's Cancer Research Founda- 
tion. A structure adequate for clinical 
investigation connected directly with 
our wards in the Farley Building is 
still lacking. The support of clinical 
investigation has been recognized as 
a need of first priority in the National 
Institutes of Health and in the sev- 
eral voluntary health agencies which 
give important support to medical re- 
search. 

The needs for expanded facilities 
for clinical research are evident in 
every Department and Division of The 
Children's Hospital Medical Center. To 
add to the research space needs of all 
previously existing Departments, there 
is the requirement for proper space ro 



house the important research activities 
of the new Bronson Crothers Profes- 
sor of Neurology, and for new special- 
ized services, such as ophthalmology 
and dermatology. 

The second recommendation of 
the Planning Committee is still the 
construction of facilities for clinical 
investigation. 

The Development of New and 
Specialized Services 

The Planning Committee in I960 
selected child neurology as the field 
of greatest importance for immediate 
development. At the request of the 
President and the Board of Trustees, 
this Committee recommended the Crea- 
don of a Division of Child Neurology 
to be named for the late Dr. Bronson 
Crothers, as the most important use 
to which a generous gift to the Hos- 
pital could be put. By arrangement 
with Dean George P. Berry of Har- 
vard Medical School and Mr. Wol- 
bach, the Bronson Crothers Professor- 
ship of Neurology was created, and 
the first incumbent was appointed July 
1, 1962. The brilliant and promising 
career of Dr. L. Lahut Uzman, the 
flrsr professor, was brought to a tragic 
and unexpected end several months 
after he began work. The story of his 
brief, extraordinary career has been 
told elsewhere (The Harvard Uni- 
versity Gazette, Vol. LVIII, No. 38, 
June 8, 1963). 

Dr. Charles Barlow, one time 
Resident here at Children's, has been 
appointed to this important professor- 
ship. His coming is awaited with 
eagerness and with appreciation for 
the role that he will fill in the de- 
velopment of child neurology at the 
Harvard Medical School and ar The 
Children's Hospital Medical Center. 
This new Department will begin in 
borrowed laboratory space, and in 
clinical facilities the inadequacy of 
which can not be remedied unril rhere 



is new construction. 

There are other specialized serv- 
ices which are receiving special atten- 
tion by the Planning Committee. In- 
vestigation has been going on for the 
past year, with the aid of Dr. Trygve 
Gundersen and the Department of 
Ophthalmology of Harvard Medical 
School, toward the creation of a Clin- 
ical and Research Division of Oph- 
thalmology. Similar studies are going 
on in the field of dermatology. 

In all parts of The Children's 
Hospital Medical Center there is a 
great need for general strengthening 
in depth of the professional personnel. 
Considerable progress has been made 
during the past year, particularly 
through the vigorous assistance given 
by Dr. Cronkhite. Much can be done 
to strengthen what we are now doing 
by utilizing to the full the resources 
presently available. Greater strength 
beyond this would require additional 
support from both private and Gov- 
ernment sources. Here again, strength- 
ening in depth requires space adequate 
to care for the activities of an enlarged 
Staff. 

The Harriet M. Peabody 
Professorship 

For some years the Trustees of the 
New England Peabody Home have 
investigated the possibilities for new 
and more effective use of their re- 
sources. Their contribution to the care 
of the crippled child has been a 
notable one. This Committee recom- 
mended to our President and his Board 
that continuation of the historical role 
of the New England Peabody Home 
could be accomplished most effectively 
by strengthening our Department of 
Orthopedic Surgery at a crucial point 
in its development. Through a series 
of negotiations conducted with imagi- 
nation, statesmanship, and vision by 
Dean George P. Berry, of the Harvard 
Medical School, and Mr. Wolbach 



118 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



with the Trustees of the New England 
Peabody Home, it became clear that 
the greatest added strength to ortho- 
pedics at The Children's Hospital and 
at Harvard Medical School could be 
obtained by the creation of a full 
Professorship of Orthopedic Surgery 
for the first time in our Hospital, with 
appropriate budgetary support of this 
Chair. This program was the final 
choice of the Trustees of the New Eng- 
land Peabody Home. The Planning 
Committee had the opportunity to par- 
ticipate in the search for the first 
incumbent and gave hearty approval to 
Harvard's appointment to Dr. William 
T. Green as the first Harriet M. Pea- 
body Professor of Orthopedic Surgery 
at The Children's Hospital. This marks 
an important milestone in our plans 
for strengthening the Departments and 
Divisions of the C H. M. C. 

The Committee expresses its great 
pleasure that Dr. Green has been given 
the opportunity to create the founda- 
tions of the Department of Orthopedic 
Surgery of tomorrow and to bring into 
reality the achievement of important 
goals toward which he has been work- 
ing with such dedication for more than 
thirty years. We once more express 
our gratitude to the Trustees of the 
New England Peabody Home for 
their generous action which has made 
possible the beginning of a new era 
in the long and distinguished history 
of Orthopedic Surgery in The Chil- 
dren's Hospital Division of the Ortho- 
pedic Department of Harvard Medical 
SchooL We hope that they will derive 
deep satisfaction from the great ad- 
vances which are certain to come from 
the developments which they have 
made possible. We congratulate Dr. 
Berry and Mr. Wolbach on this im- 
portant contribution to the strength of 
the total fabric of Harvard medicine. 



The Harvard Medical Center 
and the Affiliated Hospitals, Inc. 

The planning for the development of 
a Hospital Complex, under the auspices 
of the newly created Affiliated Hos- 
pitals, assumed a much more optimistic 
outlook with the announcement that 
Dr. Robert Glaser had accepted the 
Presidency of this new organization. 
The C. H. M. C, which is a founding 
member, has done everything possible 
to encourage the rapid fruition of these 
plans, even to the extent of delaying 
important decisions concerning the 
construction of badly needed facilities. 
The Planning Committee once more 
emphasizes its desire to have the 
C H. M C. a part of this great hos- 
pital enterprise. There is an enormous 
opportunity to give better patient care, 
to do better teaching, and to carry out 
more effective research by combining 
many activities with the larger group. 
Once more the Planning Committee 
emphasizes that when all efforts to 
combine services are finished, there will 
remain an organization devoted pri- 
marily to the infant, the child, and the 
adolescent: The Children's Hospital 
Medical Center. We still believe that 
in the future, as in the past, our great- 
est contribution will be made if we 
continue as a separate Institution, iden- 
tified with child care, but working in 
the closest possible harmony and co- 
operation with the several adjacent 
hospitals for adults, and always within 
the magnificent academic setting of 
the Harvard Medical School, the School 
of Dental Medicine, and the School of 
Public Health. 

The C. H. M. C. 

Construction Program 

The necessary preoccupation with defi- 
cits of the past several years and the 
justifiable stress placed upon the 
provision of paramedical and adminis- 
trative facilities should in no way 
detract from the urgency of our need 



for new facilities for clinical investi- 
gation and ambulatory services. There 
should be no competition between 
these two classes of construction needs 
of the C. H. M. C. Without parking 
facilities, for example, it is impossible 
to continue to give proper service to 
patients in our Hospital. The need for 
hotel, motel, apartment, and commer- 
cial services for the good of the Staff 
and the families of our patients has 
been apparent for many years, and 
provision of such facilities is in line 
with the advanced thinking in a num- 
ber of hospital organizations in this 
country. We applaud the vigorous and 
imaginative efforts of Dr. Cronkhite in 
these endeavors. 

The Planning Committee is ap- 
preciative of the business competence 
and imagination displayed by Mr. 
Wolbach, the Trustees, and the Gen- 
eral Director, and we express our 
appreciation for these heart-warming 
evidences that the breath of life is being 
blown into dreams and plans which 
have reposed too long in the deep 
freeze of economic uncertainty. As 
Chiefs of Staff, we are happy with the 
evidences of total planning now vis- 
ible on the drawing board. We must 
emphasize that while we hope all of 
these plans can be put into effect 
within the next few years, if there 
must be a choice in priority because 
of restriction of funds, our recom- 
mendations are clear. We describe 
these as follows: The provision of the 
most essential services for the running 
of the Hospital, including such ex- 
ternal needs as the parking facility; 
and, the construction in the shortest 
possible time of the buildings for 
ambulatory services and clinical in- 
vestigation. Without these the new 
clinical facilities in the Farley Build- 
ing stand alone, emphasizing all the 
more our deficiency in facilities for 
ambulatory services and for clinical 
investigation. 



We have complete confidence that 
the time is ripe for the fulfillment of 
these recommendations, and, as a Staff, 
are prepared to give every support to 
the Trustees, as we have in the past, 
in the achievement of these goals. 

The Staff Planning Committee 
would like to acknowledge here the 
devoted and effective efforts of Mr. 
Greer Williams who served the 
C H. M. C. in many capacities and 
for a time as Acting Director. We are 
grateful to him for his many important 
accomplishments during his tenure and 
wish him all that is good in his new 
professional activities. 

Sidney Farber, M.D. 

Chairman, Staff Planning 

Committee 



119 



CHAIRMAN, STAFF PLANNING COMMITTEE 



121 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



Report of Director, Employee Health Service 123 

Report of Director, Medical Records Department 124 

Report of Administrative Assistant in Charge of Ambulatory Services 126 

Report of Coordinator, Department of Patient Education and Recreation 127 

Report of Chief Pharmacist 130 

Report of Director, Physical Therapy Department 132 

Report of Director, Social Service 13 5 

Report of Manager, Surgical Appliance Shop 138 

Report of Director, Visual Education Department 139 

Report of Director of Fiscal Affairs and Controller 141 

Report of Director of General Services 144 

Report of Director of Nursing 149 

Report of Director, School of Nursing 152 

Report of Director of Personnel 156 

Report of Director, Volunteer Service 157 



123 



DIRECTOR, EMPLOYEE HEALTH SERVICE 



REPORT OF DIRECTOR, 
EMPLOYEE HEALTH SERVICE 

There have been several changes in 
Health Service physicians since the 
department's inception in January, 
1959. We were fortunate in obtaining 
Dr. Morton Franklin on September 1, 
1962, who brings to the department a 
wealth of clinical experience, a keen 
interest in the individual employees' 
problems, and the recognition for the 
need to develop more clearly defined 
and beneficial policies. 

As the attached statistics indicate, 
the functions of the department are 
diversified in scope; pre-employment 
physical examinations, medical health 
visits, immunization programs, first aid 
for industrial accidents, referrals to 
adult hospitals and to private physi- 
cians. These areas comprise a large part 
of the service but do not indicate the 
expenditure of time of both physician 
and nurse in counselling and assisting 
in solving the many social problems 
that are attendant to the employees' 
physical illnesses nor do they indicate 
the considerable amount of time re- 
quired for home and/or hospital visit- 
ing. 

In addition to the health program 
maintained for employees, medical care 
is rendered to the medical House Staff 
by Dr. Robert MacMillan. He has 
given an immeasurable service to the 
staff, arranging hospitalization, home 
visiting and telephone consultations, 
referrals to specialty services and 
processing of applications for the 
armed services and future hospital ap- 
pointments. 

Assisting Dr. MacMillan and Dr. 
Franklin has been a pleasure and it has 
been particularly gratifying to partici- 
pate in the growth of the department. 
Services to employees and House Staff 
have increased over fifty per cent in a 
three-year period so that it has become 
increasingly difficult to operate in the 
space originally provided for this unit. 
Not only has the Health Service grown 



but the increased staff and activities of 
the Personnel Department, where we 
are located, has caused the loss of an 
examining room. The waiting room 
area does not provide adequate seating 
space for the prospective employees 
and for those persons seeking health 
service. 

As we look to the future, it is 
hopefully anticipated that the Em- 
ployee Health Service will continue to 
increase its service to the employees 
of The Children's Hospital Medical 
Center and that appropriate accommo- 
dations more conducive to the privacy 
and operation of such a service will be 
forthcoming. 

Miss Hester E. Macuen, R.N. 
Director, Employee Health Service 



STATISTICS FOR 

EMPLOYEE HEALTH SERVICE 

Physical examinations 530 

Certified for employment 115 
Medical visits and health 

checkups 1143 
Nursing visits and 

consultations 2032 
3820 

Immunizations 470 

Referred for x-ray— CHMC 38 

Referred for laboratory studies 29 

Cultures 211 

Referred to Private Physicians 56 
Referred to Peter Bent 

Brigham Hospital 45 

Referred to Other Hospitals 13 

Referred for electrocardiogram 3 
Minor Industrial Accidents 

treated 42 
House Staff seen by Dr. 

MacMillan 414 



124 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



REPORT OF DIRECTOR, 
MEDICAL RECORDS 
DEPARTMENT 

The Medical Records Department con- 
tinues to have its activities continually 
increased both with respect to records 
pulled for clinical purposes and those 
for research. The perennial lack of 
adequate space for operations contin- 
ues to impede the centralization of 
certain operations which would in- 
crease the efficiency of the Department. 
It seems impossible to correct this 
situation until the new Interface 
Building becomes a reality and is 
located more centrally and in closer 
approximation to the Admitting and 
Accounting areas. One more year of 
medical records was micro-filmed in 
March of 1962 and has now been com- 
pleted. It should be noted, however, 
that micro-filming by this plan, i.e., the 
annual retirement to micro-film of one 
year's records, is not adequate for 
keeping pace with the constantly in- 
creasing demands for filing space ne- 
cessitated by ever increasing records. 
Some other solution to this space 
problem must be sought and one 
thinks of two alternatives as being 
most effective, the first being the re- 
tirement to micro-film or dead storage 
of Nursing notes which do not form 
a very considerable part of Hospital 
records, and the second, an increase in 
the number of records micro-filmed. 

During the months of June and 
August a further transfer of Hospital 
records to the basement of Peabody 
House, off Binney Street, was com- 
pleted. On July 1st, Mrs. Marie Smith, 
who had served so ably as our Chief 
Medical Records Librarian, resigned in 
order to take an equivalent post at the 
Greenwich Hospital, Greenwich, 
Connecticut. 

A number of the Department per- 
sonnel participated in training pro- 
grams and as usual, a student from the 
Massachusetts General Hospital came 
to us for one month of training in 
April. The Department continues to 



be plagued by a fairly heavy turnover 
for a variety of reasons, and in keeping 
with experience in other parts of the 
Hospital and other institutions in the 
area, there is continuing difficulty in 
obtaining secretarial personnel. The 
Department is looking forward to the 
appointment of a new director at the 
earliest possible moment. 

Miss Betsey Loveland 

Acting Director, Medical 

Records Department 



125 



DIRECTOR, MEDICAL RECORDS DEPARTMENT 



STATISTICS 1961 -1962 

Comparative Totals 1961 and 1962: 1961 1962 

Tabulated Requisitions— Recotds Pulled 75,097 80,209 

(Excluding Department use and Research) 



Telephone Calls 1961 


1962 






45,553 


50,398 




Records Pulled for Research 




6,110 


10,420 


Patients' Index — tabulated calls 




52,864 


54,527 


New Records Issued 




14,842 


15,781 


Discharged* 




9,011 


9,619 


Total Operations (Including Throat) 




5,041 


5,513 


Correspondence (Requests handled) 




5,428 


5,539 


Income 








1961 1962 









§3,069.00 $2,855.00 

Photostating (pieces) 

Inter-Departmental Transfers 
1961 1962 



8,118 



12,516 



$201.95 $104.65 

Crippled Children — authorizations 666 681 

Records Taken to Court 40 25 

* Explanatory Remarks: The items Discharged and Total Operations represent 

the work of the collating clerk in preparing the records plus the work of the 

entire secretarial section involving transcription and transmittal for signature. 

The total number of records pulled and calls to the Patients' Index, as shown, 

do not represent the total amount of work acually performed, since it is 

impossible to tabulate all requests actually completed. 



126 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



REPORT OF 

ADMINISTRATIVE ASSISTANT 
IN CHARGE OF 
AMBULATORY SERVICES 

Again during the period October 1, 
1961 through September 30, 1962, as 
in the past four similar periods, the 
Out-Patient Department showed a sig- 
nificant increase in the total number of 
patient visits. During the 1962 period 
109,317 visits were recorded, an in- 
crease of 8,208 over the same months 
of 1961, and almost 13,500 visits more 
than in the I960 period. 

To an ever-increasing extent the 
emergency clinic facilities of the De- 
partment are being utilized. Of the 
8,208 additional visits recorded in 
1962, 4,207 were to the Medical Emer- 
gency Clinic, 756 to the Surgical Emer- 
gency Clinic, and 647 to the General 
Emergency Clinic. Thus, emergency 
visits of one nature or another ac- 
counted for well over fifty per cent 
of the patient visit increase. 

In the clinics of a non-emergency 
nature, both Medical and Surgical Out- 
Patient Clinics showed increases, while 
the Orthopedic Out-Patient Clinic had 
a decrease in total patient visits. Medi- 
cal rose to 17,799 visits, an increase of 
about 1,100 from the previous year, 
while Surgical showed an increase of 
about 1,250, reaching 15,954 visits. 
The Orthopedic drop was by 268 visits, 
to a total for the year of 13,827. 

Although total patient visits is 
one measure of the volume of activity 
in an out-patient department, the num- 
ber of new patients is also an impor- 
tant figure for consideration. During 
the 1962 period, this figure increased 
by ten per cent, up from the 1961 high 
of 11,699 to 13,184 for 1962. As would 
be expected, the emergency clinics ac- 
counted for the largest proportion of 
the increase, again more than fifty per 
cent. 

Although the total patient visits 
for the Orthopedic Out-Patient Clinic 
decreased, as mentioned above, the 
number of new patients rose from 
1961 to 1962. 



Special clinics showing increases 
in total visits include the following: 
Adolescent, Cerebral Palsy, Child 
Health, Hearing-Speech, Physical Ther- 
apy, Psychiatry, Arthritis, Endocrine, 
Follow-up Medicine, General Medi- 
cine, Hematology, Nephrosis, and 
Seizure. 

In the Surgical Out-Patient Clinic, 
the number of operations performed on 
clinic patients decreased sharply, from 
1,951 during 1961 to 970 for 1962. 
But at the same time the number of 
private patients undergoing surgery in 
the Surgical Out-Patient Clinic facili- 
ties rose better than one hundred per 
cent, from 481 to 1,010. This is ex- 
plained by a change in procedure which 
saw individuals above a certain income 
level referred to private doctors in the 
Hospital rather than to clinic doctors. 

The trend that all these figures, 
and those that have preceded them in 
earlier annual reports, indicate is a 
change in the public's conception of, 
and demand from, an out-patient de- 
partment. At one time, cases seen in 
the emergency clinic were truly emer- 
gency cases; those of a severe enough 
nature to warrant immediate attention. 
Today, however, the community ap- 
pears to look upon Out-Patient as a 
dispensary-type facility, replacing the 
family doctor or the pediatrician. 

As the patient traffic through Out- 
Patient increases, continual efforts are 
being made to streamline procedures to 
both increase staff efficiency and reduce 
waiting time for the patient. Numerous 
proposed changes in methods are being 
evaluated, as is the possibility of com- 
pletely redesigning the physical area, 
including the Admitting Office section. 
Miss Dorothy Pratt, RJN. 
Administrative Assistant 
in Charge of Ambulatory 
Services 



127 



COORDINATOR, DEPARTMENT OF PATIENT 
EDUCATION AND RECREATION 



REPORT OF COORDINATOR, 
DEPARTMENT OF PATIENT 
EDUCATION AND 
RECREATION 



In March, 1961, a new department 
head was appointed to the Department 
of Patient Education and Recreation. 
For the first time the Coordinator was 
not directly involved in patient care 
and therefore was free to assess and 
administer the program. Time was 
taken to view the picture of total 
patient care and, with the administra- 
tive guidance of Dr. Lendon Snedeker, 
to consider the Recreation Depart- 
ment's role in the existing framework 
at The Children's Hospital Medical 
Center. 

It first became evident that de- 
ployment and number of staff were not 
practical for accomplishing a respon- 
sible job. With the reassignment of 
Recreation personnel on hand and the 
addition of new members, a reasonable 
plan of operation suggested itself. In 
addition to the Director, the reallocated 
staff numbered six Recreation Co- 
ordinators, qualified with college de- 
grees and a minimum of two years ex- 
perience or study in related fields. 
These coordinators were assigned one 
to each of the floors of the Hospital 
and one to the House of the Good 
Samaritan. 

Although this was a good begin- 
ning, the manpower shortage still pre- 
sented a real dilemma to the staff if 
we were to give adequate attention to 
patients with immediate problems of 
adjustment. As there was no pos- 
sibility of additional funds for salaried 
personnel, we had to look elsewhere for 
trainable, dependable help. 

A major part of the Recreation 
program is directed towards bringing 
comfort to children early in their stay 
when anxiety, loneliness, and tension 
are uppermost. Each Recreation area 
includes from thirty-five to fifty-five 
patients of a wide age range and a 
constantly changing population, so that 
many helping hands are needed. We 



increased the number of volunteer per- 
sonnel working within the Recreation 
Department, planning for intensive 
orientation and close supervision, so 
that common goals might be recog- 
nized and fostered by all personnel 
within the program. Adding up the 
total needs per five day week showed 
that from rwo to three assistants in 
each area daily, both morning and 
afternoon, a total of one hundred peo- 
ple, would provide a minimum staff. 
In addition to the volunteers, student 
nurses and student teachers assigned 
to the Recreation Department for 
training would also assist. 

Where previously a single person 
had supervised all recreation volunteers 
in the Hospital, now after a central 
orientation, each volunteer was as- 
signed permanently to a Recreation 
Coordinator in one area for training 
and work assignment. The Director 
of Volunteer Service and the Coordi- 
nator of the Department of Patient 
Education and Recreation assume dual 
responsibility for the recreation volun- 
teers. Early screening, general orienta- 
tion to the Hospital, hours of service, 
department smocks, and related prob- 
lems are the responsibility of the 
Volunteer Service. Final screening for 
the Recreation program, suitability of 
assignment, performance, orientation, 
and dependability in working with pa- 
tients, come under the supervision of 
the Recreation staff. Skillful, consis- 
tent supervision of the volunteers seems 
to be the key to their successful per- 
formance within our Hospital Recrea- 
tion program. Adequate professional 
staff has made this program develop- 
ment possible. 

The Recreation Office now houses 
a giant chart of the six Recreation 
Areas, indicating the number of as- 
sistants needed per area. Not all those 
who apply to help in the program are 



128 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



equally available for assignment. The 
majority come regularly one half day 
per week, many others come one full 
day, and student teachers and student 
nurses may work anywhere from one 
half day to four full days depending on 
their class in college and their course 
requirements. Three times yearly the 
Coordinator and an assistant undertake 
organization of a master chart which is 
the control to ensure smooth function- 
ing of the Recreation program for two 
semesters and the summer period. It 
works, and with only a few low periods 
there are the needed hands, properly 
oriented, to keep the program func- 
tioning. Summary figures of work 
hours for one year show quite clearly 
the extent of help given by these as- 
sistants: 

Student nurses 2,200 hours 

Student teachers 2,800 hours 

Daytime volunteers 8,500 hours 
Total 13,500 hours 

Astounding as this total may seem, 
when placed beside a patient census 
averaging two hundred and seventy- 
five children (out of a possible total 
of three hundred), two-thirds con- 
fined to their beds, it is immediately 
clear that every available hour of help 
is needed toward the realization of a 
thoroughgoing Recreation program for 
all patients. In time we hope to build 
a steadier corps of people giving com- 
plete coverage to every Recreation 
Area, year round. 

The breadth of both age range 
and personality of the patients poses a 
real problem of staff education and 
training. To this end, the Department 
of Psychiatry assists in training the 
Recreation staff. One of its members 
meets weekly with the Recreation staff 
for continuing education and patient 
evaluation; during 1962, this was Dr. 
Chester d'Autremonr. 

Eight meetings of varied pro- 
grams were held for the teachers of the 



Boston School Department who work 
within the Hospital to further the 
integration of formal education with the 
Hospital program. Four of these were 
with the Recreation staff concerning 
joint problems such as referral of pa- 
tients for schooling, prevention of 
conflicts in scheduling, and purchase of 
new equipment and books to enrich 
the educational library. At four addi- 
tional meetings with Dr. d'Autremont, 
study was made of the meaning of 
education to the hospitalized child, 
varied medical problems, and the spe- 
cial relation developing between teacher 
and patient in the Hospital setting. 
Combined funds of The Children's 
Hospital and the Massachusetts Audu- 
bon Society have underwritten a nature 
study program, a valuable adjunct to 
the formal tutoring program. 

The Women's Committee of the 
Hospital gives valuable assistance to 
many aspects of the Recreation pro- 
gram. Committee functions such as the 
Christmas window painting group, the 
Girl Scouts' Committee, the Holiday 
Committee, the Library Committee, 
the Gift Shop, the Christmas Card 
Committee, the Coffee Shop, and the 
Hospitality Coffees are a valuable con- 
tribution to staff, patient, and parent 
well-being. Generous funds contributed 
by the Women's Committee to the 
Recreation program provide for the 
salary of one Recreation staff member 
and for essential equipment that would 
otherwise be unavailable. Children's 
Hospital in general is indebted to the 
Women's Committee for its continu- 
ous support and inretest in all aspects 
of the Recreation program. 

The Red Cross Arts and Skills 
Program continues to be an important 
activity for the children. Through the 
generous work of Miss Amelie Pea- 
body, trained workers in ceramics and 
textile painting come to the Hospital 
each week. The long-term, children 



especially look forward to their friendly 
visits and the rewarding experience of 
working with skilled craftsmen. We 
hope to re-introduce weaving as an 
absorbing handicraft for older patients 
who may need long-term projects. 

Through the efforts of Mr. Edwin 
Bigelow of the State Street Bank and 
Trust Company and Mr. Lester Belcher, 
the Boy Scout activities of Troop #32 
have been reviralized. An organized 
group of young Scout leaders has 
given of its time weekly, bringing to 
hospitalized Scouts continuity in their 
work and introducing Scouting to 
many patients who can continue this 
worthwhile activity when they return 
home. For children faced with long- 
term hospitalization, weekly activities 
have the invaluable quality of speeding 
the days along, and being a healthy 
antidote for depression and loneliness. 
Through the cooperative efforts of the 
Recreation staff and Scouting volun- 
teers, a successful Scouting program 
was maintained continuously all year. 
We appreciate this valuable contribu- 
tion to the patient recreation program. 

The Children's Hospital is fortu- 
nate in having two large areas for 
patient entertainments. The Jimmy 
Fund Building houses an excellent au- 
ditorium for indoor activities, made 
possible for C. H. M. C patient 
functions through the kindness of Dr. 
Sidney Farber. Through the generosity 
of Mrs. Oliver Higgins Prouty, the 
Prouty Garden offers a beautiful set- 
ting for outdoor functions during the 
warm months. 

The familiar "Magic Show," made 
possible by Dr. Franc Ingraham and 
his friends; the Patient Art show; and 
a presentation by "The Magic Lantern 
Players" have become yearly functions 
that everyone enjoys. Additional activi- 
ties have included Bozo the Clown, 
special acts from the Shriner Circus, 
a play in the round by the Weston 



129 



COORDINATOR, DEPARTMENT OF PATIENT 
EDUCATION AND RECREATION 



Players, the Traveling Zoo, and the 
Royal Canadian Band. 

We have a great indebtedness to 
the many considerate people who re- 
member the children with donations to 
the Hospital Recreation program. Our 
program has expanded in many inter- 
esting directions through their gener- 
osity. Unusual play equipment for the 
yard of the House of the Good Samari- 
tan; weekly instruction in natural 
science; a growing record libary; and 
a continuous supply of felt, wool, and 
toys of every kind are only a few of the 
welcome gifts we have received. 

The Department program has ex- 
panded to include two out-patient 
areas for study and limited activity. 
Volunteers under the supervision of a 
Recreation Coordinator have observed 
and provided activities for children and 
parents during long, busy clinic wait- 
ing periods. We are continuing the 
program in the summer with an em- 
phasis on using simple recreational 
materials found in the home. In this 
way, parents may observe their children 
happily and constructively at play with 
familiar, easily obtainable materials. 
The idea of using this as a teaching 
demonstration area for parent educa- 
tion may prove worthwhile. 

As we look to the future, our 
main concern remains unchanged from 
what it was in 1961. We would like 
to orient all Hospital personnel in- 
volved in patient care to the great po- 
tential which lies in a vital recreation 
program, incorporated in the best total 
patient care program. 

Mrs. Barbara Patterson 

Coordinator, Department of 

Patient Education and 

Recreation 



130 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



REPORT OF 

CHIEF PHARMACIST 

The Pharmacy, located in its new 
quarters for the past two years, has 
continued to grow as expected, and 
although most of its stock is efficiently 
stored in this area, it is crowded and 
not adequate for the future. More 
space, centrally located, to better serv- 
ice the patients and the Hospital is a 
must in the near future if the Phar- 
macy is to be used to advantage. 

The volume of drugs dispensed by 
the Pharmacy this past year was ap- 
proximately $250,000 and is lower than 
expected due to a substantial price re- 
duction in antibiotics and a decrease in 
use of chloramphenicol which had 
accounted for a high percentage of 
antibiotic purchases in the past. 

Approximately 20,000 prescrip- 
tions, not counting those under the 
Chronic Disease Program, were dis- 
pensed to out-patients last year. This 
is a time-consuming operation because 
of the individual nature of the pre- 
scriptions, but patients experienced 
very few delays in obtaining their 
drugs. 

The Commonwealth of Massa- 
chusetts, under the Chronic Disease 
Program of the Crippled Children's 
Services, purchased a great many 
medications which were received, 
stored, and dispensed by the Phar- 
macy. There are 375 cystic fibrosis 
patients serviced under this program 
presently, and approximately 1500 
forms requesting an average of six 
medications for two to three months' 
treatment were processed last year. 
Two thousand prescriptions were dis- 
pensed to seizure patients last year 
under this same program. The Chil- 
dren's Hospital Pharmacy is probably 
the only pharmacy that dispenses 
drugs in shopping bags. 

The Pharmacy receives no direct 
monetary credit from dispensing these 
Chronic Disease prescriptions, as the 
medications are purchased directly by 
the state, although much additional 



work results. Records of the drugs 
received, on hand, and dispensed must 
be kept and two detailed reports were 
prepared monthly for the Crippled 
Children's Services and the Hospital 
Administration. A fee for each patient 
visit is received by the Hospital or the 
Seizure Unit but does not appear as a 
Pharmacy credit. 

While much time and effort was 
necessary to dispense out-patient pre- 
scriptions, the Pharmacy did not neg- 
lect the routine and special services 
for in-patients. Sterile vials of nar- 
cotics, phenobarbital, and versenate 
were supplied to the divisions in 
convenient pediatric doses which are 
unavailable commercially. Penicillin 
and streptomycin, properly labeled 
with strength and expiration date, 
were delivered to the divisions three 
times weekly as usual. Erythromycin 
and chloramphenicol, reconstituted and 
ready to use, were available as planned 
for this year. Routine stock drugs and 
many individual medications were de- 
livered daily to each division upon re- 
ceipt of requisition. Empty containers 
and any returns for the Pharmacy were 
picked up on this same trip. 

The many research departments 
and laboratories of the Hospital ob- 
tained their alcohol, drugs, and some 
chemicals from the Pharmacy, which 
was always glad to aid a doctor or 
laboratory in locating and obtaining 
any hard-to-get drug or chemical and 
to prepare it in a convenient dosage 
form, if desired. 

A pilot study in conjunction with 
Abbott Laboratories, under the super- 
vision of the Intravenous Solutions 
Committee, was run this year to evalu- 
ate a convenient, disposable, plastic, 
intravenous burette-type set. This study 
included the stocking, charging, and 
accounting for solutions, as well as 
sets. This information should prove 
valuable when the Hospital purchases 
commercial inrravenous solutions. 



131 
CHIEF PHARMACIST 



This year the Pharmacy Commit- 
tee of the Hospital Purchasing Corpo- 
ration negotiated several contracts 
enabling the Pharmacy to purchase 
Phisohex, heparin, chemicals, and tetra- 
cycline products at considerable savings 
without any sacrifice of quality. More 
drugs may be available under similar 
contracts this year and may keep Hos- 
pital Pharmacy costs from increasing. 

It is very probable that the Phar- 
macy will be asked to purchase, receive, 
and distribute such solutions and sets 
in the Hospital this year. This job will 
require added space for storage and 
will increase the clerical work of the 
Pharmacy considerably. The addition 
of a secretary to the staff of the Phar- 
macy would allow the pharmacists to 
concentrate on dispensing drugs, and 
not on assembling reports for account- 
ing or filing requisitions. 

Arthur M. Thompson 
Chief Pharmacist 



132 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



REPORT OF DIRECTOR, 
PHYSICAL THERAPY 
DEPARTMENT 

Statistics 

The Physical Therapy Department is 
pleased to report a ten per cent in- 
crease in services rendered during the 
past year, exactly offsetting a ten per 
cent decrease in 1961. This covers all 
physical therapy activities within the 
Medical Center, including the special 
polio and cerebral palsy clinics. 

Analysis of the distribution 
among in-patient and clinic and pri- 
vate out-patient services presents some 
interesting trends, illustrating aspects of 
changing character and pinpointing 
areas of present and potential develop- 
ment. Comparison with the annual 
report of two years ago illustrates some 
of these changes. 

Clinic Private 
In- Out- Out- 
Total Patient Patient Patient 
1960 28,928 63% 31% 6% 
1962 28,988 65% 26% 9% 

Physical Therapy has for many 
years been identified in this Hospital 
primarily with the care of polio cases. 
However, in spite of the radical decline 
of incidence in this disease, our treat- 
ment totals in all areas have begun to 
increase. 

Total Polio % 

1960 28,928 15,138 52 

1962 28,988 7,568 26 

The bulk of our work continues 
to be with orthopedic patients but has 
become more diversified, as illustrated 
by a drop from 52 per cent to 26 per 
cent in polio treatments without an 
equivalent drop in total treatments. Of 
further significance is the ratio of in- 
patients to out-patients. Limitations of 
space and personnel, which confine our 
Out-Patient Clinic to the mornings, are 
largely responsible for this. In a hos- 
pital of this size probably the reverse 
proportion should be true and, with 
the proposed remodeling of the De- 
partment, appreciable expansion of our 
out-patient activity can be anticipated. 



This has been a period of explora- 
tion and development of new programs 
which the annual burden of polio cases 
had hitherto limited or prevented. 
Chief among these are the use of physi- 
cal therapy in the treatment of cystic 
fibrosis and in the post-operative care 
of cardiac surgery patients. In I960, 
cardiac surgery treatments accounted 
for 0.54 per cent of the total treat- 
ments, whereas in 1962 this has in- 
creased to 4.10 per cent. Substantial 
increase in activity in the Surgical, 
Neurosurgical, and Tumor Therapy 
Divisions is noted and also in the In- 
fants' Hospital and Newborn Nursery. 
In the House of the Good Samaritan, 
the treatment load has almost quad- 
rupled in the past two years and now 
represents 14 per cent of our work. 

Staff 

Difficulty in obtaining staff replace- 
ments continues to plague us. With 
a normal complement of nineteen, we 
anticipate a 25 per cent annual turn- 
over. This could be managed without 
serious interference with patient care 
except for the usual long interval (four 
to six months) between resignation 
and replacement. The outstanding 
reputation of the Medical Center is a 
considerable asset, but we are com- 
peting on a national level where the 
shortage of trained personnel is acute. 
The major problem is a salary scale 
in this area fifteen to thirty per cent 
below the national average. In spite 
of this, only one of the eight persons 
who have resigned did so to accept 
employment elsewhere. The other 
seven were involuntary resignations 
due to marriage, moving away, etc. 

Education 

Education given and received contin- 
ues to be an integral part of our ac- 
tivities. In addition to post-graduate 
training for foreign physical thera- 
pists, our semi-annual courses on physi- 



133 



DIRECTOR, PHYSICAL THERAPY DEPARTMENT 



cal therapy in cystic fibrosis continue 
to be oversubscribed. The National 
Cystic Fibrosis Research Foundation 
offers grants to the research and teach- 
ing centers throughout the country for 
the purpose of sending physical thera- 
pists here for training. 

Major teaching responsibilities re- 
main in the undergraduate program 
at Simmons College, with which the 
Medical Center is affiliated. Since the 
beginning of this affiliation we have 
provided the major portion of the in- 
struction for 170 graduates, and cur- 
rendy have 24 students enrolled in two 
classes. 

With the diversification of our 
patient load has come an increase in 
our teaching activities within the Nurs- 
ing Service, Nursing School, and affiliat- 
ing groups. This has approximately 
doubled over the past two years. 

One of the stimulating aspects of 
our work is the opportunity of ex- 
changing ideas with physical thera- 
pists from other countries and it is 
regrettable that we are able to accept 
so few of the many who wish to come 
here. Since differences in methods 
necessitate long periods of indoctrina- 
tion before these foreign-trained physi- 
cal therapists can participate in patient 
care, we can accept exchange visitors 
for no less than a one-year period. 
Post-graduate students are accepted for 
shorter periods on a tuition basis, and 
visitors are welcome for a day or two. 
During the past two years we have 
had graduate students and visitors 
from Australia, South Africa, Ger- 
many, Lebanon, Argentina, and sev- 
eral from England and Denmark. 

We enjoy the privilege of attend- 
ing and participating in rounds and 
other teaching activities within the 
Medical Center. In addition to these 
many intramural educational oppor- 
tunities, grants from outside agencies 
have permitted staff members to at- 



tend six post-graduate courses and edu- 
cational institutes. 

Honors 

Mrs. Elizabeth Zausmer presented a 
paper on physical therapy in cystic 
fibrosis at the annual conference of the 
American Physical Therapy Associa- 
tion in Chicago. With Dr. Kulczycki 
she also participated in a three-day 
seminar on the same subject held at 
the University of North Carolina for 
doctors and physical therapists 
throughout the state. 

Miss Claire McCarthy has served 
with distinction as Chairman of the 
Committee on Education of the Massa- 
chusetts Chapter of the American 
Physical Therapy Association for the 
past two years, and several other staff 
members have served on various local 
and national committees. 

The Department has prepared 
three scientific sessions for the Massa- 
chusetts Chapter of the American 
Physical Therapy Association with full 
staff participating in planning and 
individual members presenting the 
program. These were Common Dis- 
abilities of the Hip in Children; 
Muscle Testing of the Shoulder Gir- 
dle; and Physical Therapy Following 
Three Orthopedic Surgical Procedures, 
(a) Adductor Myotomy and Heel 
Cord Lengthening, (b) Correction of 
Sprengel's Deformity, and (c) Ilio- 
psoas Transplants. All of these are 
common procedures in Children's Hos- 
pital but relatively little known in 
other areas. 

Miss Florence Lane has assisted in 
the annual two-week Institute on Cere- 
bral Palsy offered at Boston Univer- 
sity in cooperation with The Children's 
Hospital Medical Center. 

I was a speaker at the Conference 
on Clinical Education for Physical 
Therapists. 

Several staff members have been 
guest lecturers at Boston University, 



Sargent College, and at the Bouve- 
Boston School of Tufts University. 

Through the Embassy of the 
United Arab Republic, arrangements 
were made for Miss Claire McCarthy 
to spend four weeks in Cairo for the 
purpose of teaching a local physical 
therapist the appropriate physical ther- 
apy treatment for Mohamed Salem 
who had spent several months at Chil- 
dren's Hospital. "Mickey," a private 
patient of Dr. William T. Green, is 
the son of the late Salah Salem, a for- 
mer minister in the Government of 
President Nasser. 

And finally, in a lighter vein, we 
should not overlook the activities of 
our members within the Hospital, in 
the bowling league, on committees for 
the annual picnic, and the yeoman 
service of Joy Smith as Chairman of 
the annual Christmas party. 

Miss Shirley Cogland 

Director, 

Physical Therapy Department 



134 

REPORTS OF ADMINISTRATIVE DEPARTMENTS 



BADBR BUILDING OUT-PATIENT 




General Clinic 




Privates — Polio 88 


458 


General 605 


2,073 


Cerebral Palsy Clinic 





Cerebral Palsy Nursery School 

MIPC 

MIPC Outside Clinics 

Total 



Individuals Treatments 



October 1961 to September 1962 

Polio Patients in the Hospital 
Division 37 — Medical 
Division 26 — Orthopedic 
Division 36 — Orthopedic 
Division 71 
Division 72 
Division 74 

Division 28 — Tumor Therapy 
Division 25 — Private 
Division 34 — Surgical 

services (excluding polio) 
Division 37 — Medical 
Division 26 — Orthopedic 
Division 36 — Orthopedic 
Division 71 
Division 72 
Division 73 
Division 74 
Division 25 — Private 
Division 27 — Infants' Hospital 
Division 29 — Newborn Nursery 
Division 35 — Cardiac 
Division 28 — Tumor Therapy 
Division 39 — Neurological 
Division 33 — Neurosurgical 
Division 24 — Surgical 
Division 34 — Surgical 
Division 38 — Metabolic Unit 
Division 14 — ENT 

1,006 15,326 

HOSPITAL PERSONNEL 34 315 



731 1,998 



2 


31 


94 


950 


53 


1,249 


13 


1,490 


2 


120 


1 


2 


1 


1 


1 


4 


1 


2 


168 


3,849 


75 


1,112 


322 


3,496 


207 


2,746 


12 


2,376 


23 


1,163 


2 


431 


4 


119 


26 


230 


37 


504 


3 


115 


178 


1,319 


30 


481 


12 


57 


38 


701 


12 


145 


23 


319 


1 


3 


1 


9 



693 


2,531 


268 


1,040 


— 


668 


— 


2,209 


— 


1,052 


1,692 


9,498 


2,900 


28,988 



135 



DIRECTOR, SOCIAL SERVICE 



REPORT OF DIRECTOR, 
SOCIAL SERVICE 

As the Social Service Department en- 
ters its third year of transitional leader- 
ship the intent of this report is to 
accent the good fortune of the Hospital 
and of the Acting Director to have 
enjoyed the loyalty and devotion of 
such strong and conscientious staff. 
Even during the past year, a purposeful 
and consistent program has been main- 
tained and furthered in spite of my 
total absence of four months due to 
illness and leave of absence. Special 
thanks in this regard are extended to 
Miss Ethel Walsh, Chief Social 
Worker in the Psychiatry Clinic, Mrs. 
Janice Van Riper, Cerebral Palsy 
Clinic, and Miss Molly Cokin, Medical 
Out-Patient Department, for their 
great generosity and competence. In 
actuality and by plan, the department 
has been carried on under this "four- 
power conference" for approximately 
two years. Miss Walsh has now ac- 
cepted an associate professorship at the 
Simmons College School of Social 
Work, and Mrs. Frances Lewis, a staff 
member since January, I960, will as- 
sume the position of Chief Social 
Worker in Psychiatry for the coming 
year. Mrs. Van Riper will be resigning 
early in 1963 for personal reasons. It 
will be impossible to replace her, but 
we are attempting to recruit an ex- 
perienced substitute to join the ranks. 
If our own department has been 
characterized by shifting responsibili- 
ties, corresponding fluctuations within 
the Hospital have given rise to an 
uncommon amount of work in the 
form of self-examination, analysis, and 
interpretation of staff function. In July 
1961, Miss Walsh, Mrs. Lewis, and I 
completed a report of departmental 
structure and function to serve as a 
guide for the Ad Hoc Advisory Com- 
mittee appointed by Mr. Greer to 
determine future goals and to select a 
permanent director. This report of ours 
is available, and is still authentic as a 



reference for current practice. Explora- 
tions through the Personnel Depart- 
ment to "describe jobs," and conversa- 
tions with various hospital consultants, 
while they have added heavily to the 
load, have provided us with useful 
results in evaluating assets and liabili- 
ties and laying the ground for future 
planning. 

Staff 

A full staff would consist of thirty- 
three to thirty-seven professionally 
trained social workers (twenty-five 
full-time and nine part-time) and four 
case aides. There are four vacancies: 
Permanent Director; Supervisor in the 
Orthopedic area; one part-time worker 
in the Medical Out-Patient Depart- 
ment to replace Mrs. Jane Scease; and 
another part-time opening in the 
Cerebral Palsy Clinic held until last 
month by Mrs. Ann Roelofs, both 
excellent members who resigned to add 
to families. We have ten junior 
workers with less than three years post- 
graduate experience, five casework su- 
pervisors carrying in-service adminis- 
trative functions, with nineteen cover- 
ing a wide range of experience and 
services in between. We have had a 
relatively small turnover during the 
year. In addition to the changes men- 
tioned, and some shifts among case 
aides, Mrs. Phyllis Haberstroh, Psychi- 
atry Clinic, has moved with her hus- 
band to Denver, Colorado; Mrs. 
Suzanne Dubroff, also in Psychiatry, is 
working at Judge Baker Guidance 
Center; and Mrs. Barbara Schwartz, a 
part-time worker in Medical Out- 
Patient, left in the spring to accept a 
position at the McLean Hospital. 

Five new positions have been 
added over the past few months. Miss 
Mary Gavin is attempting to cover the 
whole of Surgical and Neurosurgical 
Services. Miss Ruth Shure, recently 
associated with the Home Care Pro- 



136 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



gram at Massachusetts Memorial Hos- 
pitals, has been added to the staff of 
the Nutrition Clinic. Miss Deborah 
Alden comes from the Simmons Col- 
lege School of Social Work to assist 
Miss Laird in the Seizure Clinic. Mrs. 
Mary Fogel of the Psychiatry Clinic 
has joined Dr. William Crowell, Psy- 
chiatrist, in offering part-time team 
consultation to patients of the Adoles- 
cent Unit. Miss Betsy Newman, Case 
Aide, has transferred from the Ortho- 
pedic Clinic to work under Miss 
Antoinette Pieroni in Tumor Therapy. 
Services 

Since our Committee Report of July, 
1961, describes in detail the nature and 
scope of patient, Hospital, and com- 
munity services, we will not attempt 
to do so in this report. There has 
been a significant increase in numbers 



of cases this year, even antedating 
staff additions. The following statistics 
are from September 1961 to Septem- 
ber 1962. 

Pertinent observations emerge 
from these figures. We will allude to a 
few. 

A high degree of energy and skill 
is required of the social worker in 
defining limits and determining the 
selection of cases on Services where the 
medical diagnoses themselves regularly 
manifest concomitant psychological 
and socio-economic problems. This 
fact is quickly reflected by the num- 
bers of referrals of retarded children, 
children with heart disease, epilepsy, 
and orthopedic disabilities. These diag- 
nostic groups involve a singular kind of 
discrimination on the part of the social 
worker, especially when there may only 



Service 


Comprehensive Cases* 


Limited Service* 




1960-1961 


1961-1962 


1960-1961 


1961-1962 


Medical Out-Patient 


299 


299 


116 


168 


Diabetic 


4 








Medical House 


120 


113 


54 


121 


Retardation 


219 


234 


324 


333 


Cardiology 


56 


62 


347 


340 


House of Good Samaritan 


50 


55 


271 


420 


Adolescent 


18 


22 






Family and Child Health 


46 


58 


232 


87 


Tumor Therapy 


81 


70 


61 


75 


Psychiatry 


174 


201 






Neurology 


151 


135 


28 


45 


Seizure 


119 


144 


288 


435 


Cerebral Palsy 


80 


92 


130 


247 


Orthopedic 


120 


172 


495 


571 


Mass. Inf. Paralysis Clinic 


116 


81 


205 


167 


Mary McArthur Respirator 


Unit 10 


4 


27 




Surgical 


94 


169 


15 


46 


Sarah Fuller Foundation 


53 


41 


19 


33 


TOTALS. 


. . 1,810 


1,972 


2,612 


3,088 



* Comprehensive Cases signify those families for whom continuing casework 

responsibility is assumed. 
*Limited Service Cases are those consisting only of social review and/or assistance 

with a particular concrete need. 



be one appointed to a given diagnosis. 
Certainly Mrs. Burwash, Mrs. Miles, 
Mrs. Snedeker, and Miss Laird deserve 
honorable mention for their experi- 
enced and untiring contributions to 
these strenuous assignments. 

As counterbalance, we see certain 
strategic areas with fuller coverage, 
more controllable screening of cases, 
and in some instances slower tempo, 
when profoundly disturbed social sit- 
uations can be assured of greater avail- 
ability of intensive, sustained treatment. 
Although this is possible to some ex- 
tent throughout, a few locations are 
conspicuous, such as Psychiatry Clinic, 
Medical In- and Out-Patient, Tumor 
Therapy, Neurology, and other settings 
where staff is adequate to allow for it. 

The number of Social Service cases 
in the Surgical Department is consis- 
tendy increasing, for reasons well- 
documented in Miss Gavin's report of 
her first year there. 

Throughout the Hospital, there are 
serious gaps in coverage. Notable 
among these are in the Endocrine, Dia- 
betic, Nephrosis, and Allergy Clinics. 
Neurosurgery is another growing 
source of referral of grave social prob- 
lems. Mrs. Burwash (Retardation) 
was obliged to withdraw from helping 
on this Service last July, and Miss 
Gavin will soon be unable to cope with 
these long and complicated cases. 

Teaching 

Our five supervisory positions involve 
specific teaching responsibilities. This 
group performs, directly and indirectly, 
the overall function of in-service edu- 
cation. Ten junior members receive 
weekly individual supervision; ten 
more experienced workers have the 
benefit of scheduled case consultation 
and guidance in professional develop- 
ment; and seven function independ- 
ently, administratively responsible to 
the Director, but neither supervised 



137 



DIRECTOR, SOCIAL SERVICE 



by nor supervising other staff mem- 
bers. 

Monthly department meetings last 
year held to the theme of social re- 
search, with visitors lecturing on spe- 
cial study projects underway in the 
vicinity. Dr. Tully Benaron, Psychi- 
atry Department, continued to con- 
duct a bi-weekly seminar on case pres- 
entations for those working in medi- 
cal services. A ten-hour orientation 
course was offered to students and new 
staff of the Hospital and Children's 
Mission to Children. 

Students of schools of social work 
and college "careers" students are ac- 
cepted for field placements under qual- 
ified staff members. Pressures of work 
and space unfortunately restrict the 
extent of this program, though this 
year we do have five graduate students 
from the Simmons College School of 
Social Work and Boston University. 

As to inter-professional intra- 
mural education — the sharing of 
knowledge with medical personnel, 
Psychiatry, Nursing, Physical Therapy, 
teachers and recreation workers — we 
have a few activities on all fronts. We 
cannot be grateful enough for the 
wealth of learning made available to 
us through all these fields, and there 
is little doubt that the freedom of ac- 
cess to such valuable opportunities has 
much to do with maintaining stability 
of staff. Our own teaching of others, 
except through case demonstration, has 
a long way to go, especially with medi- 
cal personnel itself. Miss Dorothea 
Chickering, Educational Casework 
Consultant with the Family Care Pro- 
gram, a Harvard Medical School ap- 
pointment, is the only one of our staff 
in a formal teaching relationship with 
medical student curriculum. Indeed, 
even for the House Officers, the only 
device of academic import arises in 
the ward meetings on the Medical and 
Orthopedic Divisions, and clinical con- 
ferences in the Medical Out-Patient 



Department. While most of these ses- 
sions are service-oriented, they vary 
according to leadership and to the 
acumen of participants, and frequently 
discussions of individual patient man- 
agement are consciously utilized to 
illustrate principles of comprehensive 
care. 

Research 

Three staff members have participated 
in research projects during this year. 
Mrs. Anita Dankner and two case aides 
continue to review and sustain 
follow-up of those families under the 
Maternal and Infant Health Study. 
Mrs. Anne Roelofs shared in the Child 
Accident Study directed by Dr. Roger 
Meyer of the Child Health Division. 
Miss Molly Cokin and a case aide par- 
ticipated in planning and implement- 
ing a pilot study to evaluate the rea- 
sons for parents' failure to keep ap- 
pointments in the Medical Out-Patient 
Clinic. 

We have no identifiable research 
in operation under our own auspices. 
One can say, however, that our two 
most active committees, one an Edu- 
cation Committee, and the other on 
Personnel Practices, have succeeded in 
sharpening research interest and in 
stimulating exploration of many av- 
enues of practice. Although these com- 
mittees are not of "design research," 
they show a trend towards more dis- 
ciplined study, a stepping-stone per- 
haps towards formal research, but a 
very real one nonetheless. 

In closing, we should like to ex- 
press our appreciation to those in ad- 
ministrative relationship to our de- 
partment who have given the personal 
warmth and support to carry us 
through the past year. 

Miss Elizabeth Maginnis 
Acting Director, Social Service 



138 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



REPORT OF MANAGER, 
SURGICAL APPLIANCE SHOP 

The past year was indeed a busy one. 
The volume of work received was fif- 
teen per cent greater than the previous 
year's and thirty per cent greater than 
two years ago. There were 6,707 or- 
ders completed within the year, 
ranging from minor repairs to elabo- 
rate braces. The department has not 
increased its staff during the past two 
years; however, it was necessary, dur- 
ing the summer vacation period of 
1962, to work overtime in order to 
speed up the delivery of braces. The 
vacation months always present a 
problem, since the department is con- 
stantly short-handed during this period 
and the number of orders reaches its 
highest yearly peak and pressures for 
quick deliveries increase due to plans 
for camp, etc. 

During the year, a cost analysis of 
sixty of the appliances which are made 
in the department was completed. Such 
an analysis had not been done since 
1959. A new price list was established 
to bring charges more in line with 
operational expenses. The revised 
charges became effective September 1, 
1962. A review of other appliances 
as well as repair work will be made 
during the coming year. The benefits 
of the new price list will not be re- 
flected in this year's activities, because 
its effective date was so near to the 
end of the fiscal year. However, the 
coming year should narrow the gap 
between income and operational costs 
considerably. 

Professor Robert W. Mann of the 
faculty of the Massachusetts Institute 
of Technology visited the department 
with several of his Engineering stu- 
dents. Professor Mann has first-hand 
knowledge of bracing problems, as he 
has participated in brace research with 
a Massachusetts General Hospital 
group. He also served on an advisory 
committee to the American Orthotics 
and Prosthetics Association which did 
a survey of orthotics in the United 



States for the United States Govern- 
ment's Office of Vocational Rehabilita- 
tion. One of the students, Mr. William 
Pettus, chose to do a thesis on the pos- 
sibility of designing a mechanical 
pelvis, which would be the basic com- 
ponent for a whole new concept of 
bracing. 

The Surgical Appliance Shop par- 
ticipated in the national orthotics sur- 
vey mentioned above as one of the 
facilities canvassed. I served on the 
survey's Content Committee. 

With an eye to the future, the 
department enrolled its first trainee in 
a formal four year training course. 
This individual will be exposed to all 
aspects of bracemaking during his 
training. 

John Glancy 
Manager, Surgical Appliance Shop 



139 



DIRECTOR, VISUAL EDUCATION DEPARTMENT 



REPORT OF DIRECTOR, 
VISUAL EDUCATION 
DEPARTMENT 

This Deparment continues to be very 
busy, as is clearly shown in the Statisti- 
cal Reports below. The following is a 
selected s umm ary of our work. 

Several exhibits were produced 
during the past two years for the 
Orthopedic Department and other 
Services. The largest of these, both in 
physical size and quantity of prints, 
was made for Dr. Clement A. Smith. 

A number of teaching motion 
pictures have been made for Dr. 
Henry H. Banks, Dr. William T. 
Green, and the Surgical Research 
Laboratory. Magnetic sound was re- 
corded on film for Dr. Richmond S. 
Paine, Dr. Arthur W. Trott, and the 
Surgical Research Laboratory. 

Late in 1961 experimental work 
was started on recording fluorescent 
phenomena at high speed under ultra- 
violet light. The experiments are con- 
tinuing on a successful basis. Further 
work on improved equipment is being 
carried out to cover larger areas of 
fluorescence than is possible with 
present equipment. Our exposures are 
at 1/500 second, covering, at present, 
an area of about four square feet. We 
hope to be able to include, eventually, 
an area of sixteen square feet. This 
work has been carried on without cost 
to the Hospital. 

Research was completed and a 
successful motion picture made for the 
Department of Radiology. This film 
makes it possible to show x-ray motion 
pictures made at a low film speed, of 
catheterization of the heart, etc., with- 
out the need of a special motion pic- 
ture projector. This seems to solve 
the problem of carrying a special type 
of heavy motion picture projector to 
meetings outside the Hospital. This 
may well become a routine procedure. 

One paper was published during 
the period covered by this report: 
"Lights and Lighting," F. R. Harding, 
FBPA: JBPA, Volume 28, #3. Another 
paper, "High Speed Color Photog- 



raphy of Fluorescence by UV Light," 
was read at a meeting of the Boston 
Chapter, Biological Photographic As- 
sociation. 

Our deep appreciation to Mrs. 
June Armstrong and Miss Pauline Mc- 
Rae for their cooperation and constant 
efforts to improve our biophotographs, 
and for their cheerfulness, under some- 
times difficult circumstances. 

F. R. Harding, Director 
Visual Education Department 



140 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



DEPARTMENT OF VISUAL EDUCATION 


DEPARTMENT VISUAL EDUCATION 


STATISTICAL REPORT 1961 




STATISTICAL REPORT 1962 




Service 


Cases 
500 


Photos 


Service 


Cases 
A7A 


Photos 


Orthopedic 


2014 


Orthopedic 


1802 


Surgical 


270 


662 


Surgical 


111 


461 


Medical 


780 


1631 


Medical 


721 


1577 


Neurosurgical 


87 


264 


Neurosurgical 


150 


348 


Infants' Hospital 


48 


114 


Infants' Hospital 


79 


173 


Pathology 


496 


1017 


Pathology 


463 


987 


Tumor Therapy — 






Tumor Therapy 






Clinic & Division 


313 


901 


Clinic & Division 364 


1057 


Massachusetts 






Massachusetts 






Infantile Paralysis 






Infantile Paralysis 






Commission 


97 


413 


Commission 


49 


196 


Private Office 


270 


728 


Private Division 


305 


980 


Private Division 


381 


1186 


Private Office 


220 


581 


Adolescent Clinic 


4 


5 


Cerebral Palsy Clinic 25 


190 


Cerebral Palsy 






Growth Study 


14 


28 


Clinic 


10 


86 


Neurology 


6 


18 


Newborn Nursery 


7 


13 


Adolescent Clinic 


7 


15 


House of the Good 






Newborn Nursery 


7 


18 


Samaritan 


6 


11 


Child Health Clinic 


3 


6 


X-ray Therapy 


8 


21 


X-ray Therapy 


2 


4 


Neurological 


16 


42 


Dental Clinic 


3 


14 


Dental Clinic 


4 


13 


Total 


3113 


8455 


Child Health 


2 


3 


Misc. Negatives 




2680 


Otolaryngology 


1 


2 


Misc. Prints 




6404 


Total 


3300 


9126 


Standard Lantern 






Misc. Negatives 




2579 


Slides B&W 




1602 


Misc. Prints 




7667 


35MM. Lantern 






Standard Lantern 






Slides B&W 




1661 


Slides B&W 




1698 


Standard Lantern 






3 5 MM. Lantern 






Slides Color 




240 


Slides B&W 




1771 


3 5 MM. Lantern 






Standard Lantern 






Slides Color 




607 


Slides Color 




217 


Motion Pictures 




300 


3 5 MM. Lantern 






Motion Picture Footage 


13,390 


Slides Color 




457 


Total Negatives, 






Motion Pictures 




277 


all purposes 




11,325 


Motion Picture Footage 


11,275 


Total Prints, 






Total Negatives, 






all purposes 




14,949 


all purposes 




12,488 


Total Charges 


$17,017.57 


Total Prints, 












all purposes 




16,792 








Total Charges 


$17,679.51 









141 



DIRECTOR OF FISCAL AFFAIRS AND CONTROLLER 



REPORT OF DIRECTOR 
OF FISCAL AFFAIRS 
AND CONTROLLER 

This report describes the comprehen- 
sive program undertaken by the Con- 
troller since coming to this Institution 
in September I960. We believe that 
a description of the accomplishments 
under this program, plus a preview of 
future plans, will adequately cover the 
activities administered by the Con- 
troller. 

These functions cover: 
Accounting 

General 

Cost 

Patient billing 

Collection of accounts 
Purchasing and Disbursements 
Systems and Procedures 

Methods improvement 

Work simplification 

Forms design and control 
Data Processing 
Special (ancillary) services 

rate structure 
Financial and statistical reports 

In 1961, in view of the mounting 
deficit and recognizing that the cur- 
rent financial information was inade- 
quate both for evaluation of current 
operations and future decision making, 
we prepared and submitted to the 
Executive Committee of the Boatd of 



Trustees, Administration, and Chiefs 
of Staff, a divisional income statement 
and report using cost allocation tech- 
niques. This report showed the mag- 
nitude of the total loss and the relative 
losses by revenue centers: in-patient 
areas, forty-six per cent; out-patient 
areas, thirty-four per cent; research 
areas, twenty per cent. Based on this 
analysis, we made specific recommen- 
dations to reduce the operating losses 
in each area. 

Accounting Department 

In 1962, we implemented these rec- 
ommendations in the major revenue 
areas by revising the patient rate 
charge structure. The effect upon an- 
nual income, based on 1962 occu- 
pancy and utilization of Hospital serv- 
ices, is estimated below. 

Implementation of our recom- 
mendations in other areas was de- 
ferred in 1962 because of the priority 
assigned to increasing revenue in the 
major areas listed. A description of 
these other recommendations will be 
included at the end of this report in 
the paragraphs devoted to our future 
plans. 

During these two years, many 



New Charges Established 

Central sterile supplies used for patient care on the 

nursing divisions and in the out-patient clinics 
Recovery service following anesthesia 

Current Charges Updated 
Anesthesia service 

Appliances — surgical and orthopedic 
Blood Bank services 
Electroencephalography 
Operating room 

Day rates (approved by the Executive Committee 
of the Board of Trustees) 

(Includes $20,000 realized by elimination of 

$1.00 per day discount) 

Estimated annual effect of changes 



Increased 
Annualized Billings 

% 13,000 
59,000 

37,000 
15,000 
12,000 
20,000 
140,000 



195,000 



$491,000 



142 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



changes and improvements have been 
effected in the various sections of the 
Controller's Department. Some in- 
volved extensive systems and proce- 
dural changes; others involved less in 
the way of systems work and sub- 
stantially more in day by day follow-up 
of routine functions. An example of 
the latter is the improvement in the 
collection of patient receivables. It is 
worth stating here, in order to under- 
stand patient billing and collection, 
that fifty per cent of our patients have 
Blue Cross insurance, twenty per cent 
have other insurance coverage, and 
fifteen per cent are subsidized by wel- 
fare agencies. Most of the remaining 
fifteen per cent are medically indigent 
and require substantial or total free 
care charitable allowances. 

One reason for the reduction of 
patient receivables, as shown below, 
is the accelerated processing of Blue 
Cross and other insurance claim forms. 
Two years ago, many insurance claims 
were not filed until six months after 
the patients' discharge. Contributing 
to this delay was the fact that separate 
claims had to be filed by the Children's 
and Infants' Hospitals, House of the 
Good Samaritan, and the Respirator 
Unit because of individual contracts 
between each institution and Blue 
Cross. In October 1961, we were suc- 
cessful in negotiating one consolidated 
contract with Blue Cross. This major 
step, plus improvement in our inter- 
nal claim processing procedures, makes 
it possible for us to file currently all 
claims for Hospital reimbursement. 

The other factor resulting in the 
reduction of patient receivables has 
been increased attention to our cur- 
rent outstanding accounts. In addition, 
we have reviewed the older accounts 
(dating back to 1958-1959-1960) and 
cleared up a substantial number of 
them through the issuance of chari- 
table allowances, where indicated, as 
an inducement to settlement. 



A few figures will illustrate the 
effect of the prompt insurance claim 
filing and our current collection ac- 
tivities: 
In-patient receivables, 

September 30, 1961 $1,615,000 
In-patient receivables, 

September 30, 1962 1,490,000 
Decrease in outstanding 
balances $ 125,000 

However, the improvement in col- 
lections is significantly greater, be- 
cause in-patient billings in 1962 of 
$4,512,000 exceeded 1961 billings by 
$542,000, thus increasing the cash flow 
$667,000. 

Purchasing 

Other changes in the department 
required extensive systems and pro- 
cedure review with implementation by 
written standard procedures such as 
the revised purchasing-disbursement 
procedures initiated this year. This 
involved the transfer of the invoice 
audit function to the Disbursement 
Accounting Office and the central 
stores inventory to tabulating equip- 
ment (12,000 purchase orders and 
27,000 voucher invoices processed an- 
nually). The tabulated store inven- 
tory shows at a glance the reorder 
quantity point and the normal stock 
quantity for each item. The result 
has been to decrease paper handling in 
the Purchasing section, thereby mak- 
ing available more time for the buying 
function. 

Methods and Forms Control 

This section is responsible for a course 
in work simplification for employees, 
the coordination of systems and pro- 
cedural studies, and for the design and 
control of all Hospital forms. During 
the past two years, the Forms Control 
Office has designed or revised many 
forms used throughout the Hospital, 
such as admission form, daily census 



summary, purchase order, fund drive: 
combined gift list and deposit slip, 
preprinted charge requisitions, etc. 
These changes resulted from our De- 
partment activity and from regular 
form revisions as required by other 
departments. This has been a very 
effective program working toward uni- 
formity throughout the Hospital in 
form design as well as reduction of 
paper work costs. 

Data Processing 

The increasing complexity of The 
Children's Hospital Medical Center has 
made it necessary to transfer addi- 
tional functions to our data processing 
equipment. Some of the activities 
which have been tabulated during the 
past two years are: 
A comprehensive space utilization 
survey by buildings and service func- 
tions for the management consultants 
in such a manner that the data are 
available for administrative control of 
physical facilities. 

Departmental equipment asset pur- 
chases during the past two years and 
die related depreciation provisions re- 
corded on punch cards. The resulting 
tabulation provides the analysis that is 
required by the Massachusetts Division 
of Costs and Finances during its annual 
audit to establish our welfare reim- 
bursement. 

Pharmacy Department inventory at 
the end of the 1962 fiscal year to ex- 
pedite the annual closing and to pre- 
pare for the future transfer of all phar- 
macy transactions to tabulating. 

The establishment in 1962 of 
charges for central supply services also 
required a systems and procedures re- 
view coordinated with certain Nurs- 
ing Department functions. This was 
a successful collaboration and was the 
first step in a comprehensive data proc- 
essing program using prepriced IBM 
card charge requisitions. 



143 



DIRECTOR OF FISCAL AFFAIRS AND CONTROLLER 



Our present procedures represent 
a basic utilization (2,000,000 cards 
processed annually) of our punched 
card equipment; e.g., general ledger, 
special fund ledger, voucher and pay- 
roll disbursement, revenue and ex- 
pense distribution, charge card requisi- 
tions, etc. In 1963, we plan to further 
integrate revenue, expense, and sta- 
tistical data with mechanized data 
processing procedures — including rec- 
ommendations made in our earlier re- 
ports. The object of this comprehen- 
sive program is to mechanize certain 
functions, which at present require 
manual clerical time, by transferring 
them to our data processing equip- 
ment. The benefits derived should be 
the tabulation of more timely, accurate, 
and effective reports for decision mak- 
ing, and a reduction in direct and in- 
direct clerical costs. 

The comprehensive program 
covers: 

Patient Admitting Statistics 
Establish patient master record in 
the data processing files from source 
data obtained at admission: name, 
medical record number, geographical 
code, insurance code, doctor's code, 
admission diagnosis code, division and 
room number, etc. From this stored 
and updated information, reports may 
be tabulated, such as daily census by 
nursing division, showing patient, con- 
dition, admittance date, service, age; 
bed capacity and occupancy; monthly 
summary of patient statistics, etc. 

Ancillary Service Charging 
Establish (a) in the data process- 
ing file, a master price list and a nu- 
merical code for all special (ancillary) 
services and (b) uniform patient 
charge system. Because of inter-rela- 
tionship, these combine to make a joint 
project. The present preprinted and 
prepunched IBM card requisitions 
should be standardized for uniform 



use throughout the Hospital in both 
the in-patient nursing units and out- 
patient clinics. A copy of each service 
requisition will be sent to the Data 
Processing Office for pricing the serv- 
ice and billing the patient. The tabu- 
lated output will provide current and 
cumulative revenue data and, most im- 
portantly, timely statistical data for 
each service rendered by each ancillary 
department. The benefits of mechani- 
zation in these functions are obvious. 

Accounting and Cost Control 
We also plan to implement an im- 
portant recommendation made in our 
earlier report. This recommendation 
is the assessment of all research grant 
activities for occupancy and adminis- 
tration overhead. Our present overhead 
is approximately twenty-five per cent 
of our total research grant expendi- 
tures. However, the present overhead 
reimbursement averages only six per 
cent. "We plan to review each research 
area and recommend an equitable over- 
head rate to be assessed against the 
grant. 

Because of the rising cost of pro- 
viding out-patient services, including 
accounting and billing clerical opera- 
tions (40,000 account cards require 
160,000 annual postings), we believe 
that the out-patient and private ambu- 
latory areas should operate on a cash 
basis. We plan a review of procedures 
to determine the feasibility of convert- 
ing to a cash basis. 

In addition to the monthly com- 
parative financial statements, we shall 
issue in the new fiscal year, quarterly 
departmental cost reports which will 
provide department heads with cur- 
rent departmental ratio of operating 
expenses to revenue. The present high 
ratio of expenses to revenue (one hun- 
dred twenty per cent) emphasizes the 
need for constant departmental con- 
trol, where possible, of costs and rev- 
enue. 



Our goal during the past two 
years has been, and it will continue to 
be, the reduction of loss from opera- 
tions. To this end, we will continue to 
direct our efforts toward: 

1. The maintenance of a current, com- 
prehensive, and realistic rate struc- 
ture covering all services rendered 
to patients, other departments, and 
other institutions. 

2. The implementation of this rate 
structure by effective data process- 
ing. 

3. The increased utilization of data 
processing equipment to provide 
Administration, Chiefs of Service, 
and Department Heads with good 
managerial tools and to reduce 
clerical costs. 

Richard E. Held, CFA 

Director of Fiscal Affairs 

and Controller 



144 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



REPORT OF DIRECTOR 
OF GENERAL SERVICES 

The administrative departments 
grouped under the heading of general 
services include the Dietary Depart- 
ment, Plant Operations, Housekeeping, 
Linen Service, the Mail Room, the 
Print Shop, Special Services, Communi- 
cations, and the Reception and Mes- 
senger Service. During 1962, a num- 
ber of significant changes in the 
personnel and operation of these areas 
was accomplished. 

Dietary Department 

Mrs. Martha Stuart, Chief Dietician, 
retired in October 1962 after thirty- 
seven years of excellent service to the 
Hospital. The difficulty of replacing a 
Department Head who has served for 
such a long period cannot be over- 
stated. However, the Hospital was 
fortunate in finding Miss Maxine Gil- 
son, a graduate of San Jose Teachers 
College in California and of the Massa- 
chusetts General Hospital's course in 
Dietetics. Subsequent to the comple- 
tion of her training at Massachusetts 
General Hospital, Miss Gilson joined 
the Dietary Staff there and in 1959 was 
appointed Assistant Director of the 
Dietary Department until she joined 
The Children's Hospital Medical Cen- 
ter as Director of the Dietary Depart- 
ment on September 10, 1962. 

Miss Gilson manages a depart- 
ment of sixty people who must serve 
approximately 2,000 meals every day 
to patients and staff. It is significant 
to note that the number of meals 
served to staff and employees in the 
cafeteria is more than double the num- 
ber of meals served to our patients. 

This tremendous growth of staff 
and employee feeding has, during re- 
cent years, demanded much of the 
attention of management. It is now 
time to place considerable stress on 
improving the methods and technique 
of serving our patients. Miss Gilson 
is placing emphasis on this area which 
must, of course, have first priority. 



During the summer and fall of 
1962, major alterations and additions 
were made in the staff and employee 
dining area. The Trustee Building 
Committee authorized the addition of 
a new cafeteria serving line primarily 
for the use of the professional staff and 
an enlargement of the seating capacity. 
Also, at this time major changes were 
made in the existing dishwashing and 
set-up areas for the cafeteria lines. We 
have been fortunate in having a large 
and well-equipped main kitchen which 
was designed and built in 1954-56. 

The feeding of the rapidly in- 
creasing number of children and their 
parents who are here as out-patients 
and must remain over a meal hour is a 
problem that the Hospital must soon 
meet. The Women's Committee Lunch 
Shop continues to make a major con- 
tribution in this area, but its location 
is away from the Out-Patient area. The 
vending machines, which dispense over 
425,000 portions of food and beverage 
each year, are in an area which has no 
seating and where not more than ten 
persons may stand at one time. Plans 
are under way to improve this situa- 
tion, recognizing that a convenient 
eating place for our out-patients and 
their parents is of utmost importance. 

Plant Operations 

During 1962, this Department was re- 
organized. The post of Engineer for 
Planning and Construction was estab- 
lished and Mr. Arthur W. Stomberg, 
our Plant Superintendent, was pro- 
moted to this position. Mr. Stomberg 
now has overall responsibility for 
maintenance and engineering, but will 
devote most of his time to assisting and 
advising the Medical and Administra- 
tive Staffs on the feasibility, design, and 
costs of proposed major renovations 
and new construction. It will be his 
function to interpret the need for new 
facilities, as expressed by the Hospital 



145 



DIRECTOR OF GENERAL SERVICES 



Staff, to the consulting architects and 
engineers. Insurance of adequate owner 
supervision of construction contracts 
will also be his responsibility. 

Mr. George Stilgoe was employed 
to replace Mr. Stomberg as Plant Super- 
intendent. Mr. Stilgoe has had extensive 
experience in construction and plant 
supervision since his graduation from 
M. I. T. in 1934. Mr. Stilgoe will con- 
tinue the efforts of the Plant Opera- 
tions Department to place major stress 
on preventive maintenance. This be- 
comes most important as the machinery 
and equipment required to support 
modern medical care become increas- 
ingly complex. 

Once again we may use the con- 
sumption of electric power as an 
approximate index of the increased 
activities and growth of the Institution. 
Our demand reached 1,450 kilowatts 
during June and July; this means that 
during at least one fifteen minute inter- 
val in those months we were using 
electricity at the rate of 1,450 kilowatts 
per hour. Because of this high usage it 
is necessary for us to purchase our 
electricity at 13,800 volts, requiring the 
installation of a new high voltage dis- 
tribution system. It is anticipated that 
engineering studies will start shortly, 
coordinating this work with our overall 
building program. 

An area in which this Department 
is always busy, and this year has been 
no exception, is planning and perform- 
ing a variety of internal alterations 
reflecting the changing activities of the 
Hospital. A Service is enlarged, a func- 
tion is added or dropped, an area is 
changed for added efficiency, all usually 
requiring some physical alterations, be 
it a complex partition or simple cabi- 
net. All requested work is carefully 
studied to provide the most satisfactory 
results with the least overall cost to the 
Hospital. From previous experience in 



doing similar work for others, the 
Plant Operations Department is fre- 
quently able to suggest improved 
methods, equipment, or work patterns. 
It is most rewarding, personally to the 
Department, and financially to the 
Hospital, to see an estimated $1,500 
approved cabinet work project in- 
stalled at less than half cost simply by 
a careful study of the function in 
action. While all projects don't return 
such high dollar dividends, the same 
study is applied to all, often with sub- 
stantial economies effected. 

It would not be practical to list all 
of the projects undertaken this past 
year, but each was interesting and 
many had their problems, as those in- 
volved are well aware. The x-ray 
film processing area was remodeled, 
and a new automatic film processing 
machine added. While this Depart- 
ment did the work, Mr. Eric Ham- 
mond, of the Radiology Department, 
did the planning. A large house trailer 
was remodeled and set near the Per- 
sonnel Department area, providing 
perhaps the least expensive office space, 
per square foot, that we have. The 
ground floor research laboratories in 
the House of the Good Samaritan were 
remodeled, and the construction prob- 
lems were often unexpected. Remodel- 
ing work was done in the Cardiology 
Department, the Out-Patient Admit- 
ting area, and the Medical Records file 
area, among others. Following the start 
of our laundry processing by the Hos- 
pitals' Laundry Association, Inc., the 
upper floor of the laundry building was 
remodeled to include the sewing, uni- 
form, and clean linen operations, while 
the Print Shop moved into the ground 
floor of the same building. A fire 
alarm system was installed in Building 
A, and the diner building on the 
Brookline Avenue parking lot was de- 
molished. There were, of course, many 
other projects, but this list shows the 



variety of our minor construction du- 
ties. 

Planning and executing renova- 
tions and construction jobs may be the 
more exciting aspect of the Depart- 
ment's work, but there is another side 
more vital to the operation of the 
Hospital: the maintenance of the plant 
and equipment. Some of these opera- 
tions were relatively spectacular, such 
as the removing and replacing of the 
brick corners of Gardner House. Most 
of the work is unsung, as it should be, 
its only measure of recognition being 
that if the work were not effective, 
everyone would sing out. The anonym- 
ity of our routine maintenance attests 
to its effectiveness, since a working 
hot water faucet causes no comment. 
Our system of painting patient areas 
on a pre-scheduled basis worked like 
a charm. An innovation in the area 
of routine maintenance should be men- 
tioned whereby this Department has 
assigned personnel to work directly 
under the Housekeeping and Special 
Service Departments. Designed to de- 
crease paper work, phone calls, etc., the 
results so far are quite gratifying. 

Housekeeping 

On April 1, 1962, the Hospital ap- 
pointed Mr. Lawrence Levinson as 
Manager of the Housekeeping Depart- 
ment. Mr. Levinson holds a B. S. degree 
in the physical and biological sciences 
from the University of Massachusetts. 
Since graduation, he has worked in the 
dairy industry as a production superin- 
tendent and as a plant superintendent. 
The Hospital has indeed been 
fortunate to find a man who has both 
the experience and technical ability to 
manage this large Department. Per- 
haps even more impottant is the en- 
thusiasm he directs toward raising the 
status of the housekeeping personnel 
and the standards of their work. His 
first report follows: 



146 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



"It is axiomatic among adminis- 
trators, hospital or otherwise, that 
effective work performance must be 
preceded by a well-designed Organiza- 
tion Chart. The Housekeeping Depart- 
ment, guided by consulting specialists, 
created such a chart early in 1962. It 
is a good one, refined and sharpened 
by comprehensive job descriptions. The 
efforts of the Department have been 
devoted since the spring of 1962 to 
translating this organizational guide 
into reality. This means, essentially, 
that properly oriented people must 
either be recruited or trained to fulfill 
the positions of supervision and leader- 
ship which the chart calls for. To sat- 
isfy our obligation in maintaining 
acceptable standards of environmental 
cleanliness, the organizational comple- 
ment requires one hundred thirty 
people. 

"It is appropriate to point out the 
broad scope of our responsibilities, 
both in respect to the physical layout 
of our buildings and in respect to the 
diverse functions which we perform. 
The half -million square feet of floors 
and the 2,600 offices, laboratories, pa- 
tient rooms (with their related utility 
areas, nurses' stations, playrooms, and 
parents' rooms), libraries, clinics, lav- 
atories, record and file rooms, service 
areas, residences, class rooms, x-ray and 
operating areas — all are scheduled for 
day-in, day-out care by Housekeeping 
personnel. Just a few representative 
figures will demonstrate the degree of 
activity that our center of operations, 
the Housekeeping Office, controls. We 
have 6,500 windows to be washed, 
draped and shaded. The daily distri- 
bution, marking, and repair of laundry 
and linen room items runs into the 
thousands. Waste for disposal from our 
various buildings accumulates to the 
volume of some 300 cubic yards a 
week. An important responsibility of 
our patient area personnel is the 
cleaning and decontamination of isola- 



tion rooms in conformity with pro- 
cedures established by the Nursing 
Department and the Committee on 
Infections. Finally, the establishment 
of new offices and the shifting of old 
ones demands availability of manpower 
to effect these moves. 

"In order to maintain the organi- 
zational discipline necessary to fulfill 
this variety of functions — most of 
them simultaneously — it is obvious 
that personnel who are not recruited 
from the ranks of skilled workers must 
have the benefit of training, guidance, 
motivation and above all, supervision. 
In pursuit of this end, with the support 
of the Administration, a new approach 
to the training of supervisory personnel 
was introduced on July 1, 1962. The 
following description was released to 
vocational guidance counselors in local 
and some suburban high schools, as 
well as to employees of the Housekeep- 
ing Department, in April, 1962: 

This program offered by The 
Children's Hospital Medical 
Center is designed to pre- 
pare high school graduates 
and other qualified applicants 
for career opportunities as 
supervisors in the rapidly ex- 
panding service function of 
hospital housekeeping sanita- 
tion. As hospital facilities 
across the nation continue to 
grow, the need for qualified, 
technically trained service 
supervisors grows simultane- 
ously. The program is an 
integration of: 

1. Classroom Instruction 

2. Practical Project In- 
struction 

3. Participation in Hospi- 
tal Work Schedule 

4. Actual Supervisory Ex- 
perience 

Trainees completing the pro- 



gram will earn a certificate 
from The Children's Hospi- 
tal Medical Center Super- 
visory Training Program in 
Housekeeping and Sanitation. 

Selections were made and a group of 
sixteen trainees became the first class 
of its kind in The Children's Hospital. 

"In addition to the learning of 
proper procedures for accomplishing 
assignments in cleaning, there was 
much more, it was felt, the trainees 
should be exposed to: for example, the 
bacteriological reasons for sanitation; 
the history of our Hospital which will 
soon celebrate its one-hundreth year; 
the functions of the Medical Services 
in whose areas much of our work is 
performed; a familiarity with the 
modern concept of work methods; the 
techniques of supervision with its over- 
tones of motivating and influencing 
subordinates; and publications and 
periodicals dealing with hospitals and 
hospital services. 

"The intention of designing the 
course in this way was to cultivate an 
attitude of pride in the Hospital and in 
the significance of their employment. 

"The first quarter of the course 
(July, August and September) was 
successfully concluded with gratifying 
evidence that our efforts were already 
delivering results. Several appoint- 
ments to lead positions in both the 
patient area and the building services 
have been made from among the class 
members. As we proceed to further 
strengthen our supervisory group, work 
methods will become a more promi- 
nent project; and on this will be based 
studies of increased mechanization, 
simplification, and greater efficienq'." 

Linen Service 

The year 1962 saw the first full 
twelve months of operation of the Hos- 
pitals Laundry Association, Inc. Dur- 
ing the year, The Children's Hospital 



147 



DIRECTOR OF GENERAL SERVICES 



Medical Center sent 1,616,684 pounds 
of soiled linen to this central laundry. 
For this service, and including the ad- 
ditional service of starching and iron- 
ing thousands of uniforms, we paid 
§133,292. This Hospital's linen makes 
up 17.6 per cent of the total load of 
the central laundry, making us a distant 
second to the Massachusetts General 
Hospital (53.6 per cent). 

It has been noticed by The Chil- 
dren's Hospital Medical Center that the 
service provided by the central laundry 
has steadily improved during the year, 
and with active participation by Mr. 
Levinson, who serves on their Operat- 
ing Advisory Committee, we expect 
further improvement. It is also antici- 
pated that the cost to the Hospital for 
this service will continue to decrease 
during the coming year. 

Print Shop 

The Print Shop continues to grow and 
expand its services to this Hospital 
and, when possible, to affiliates and 
surrounding institutions. Mr. Salva- 
tore Caliguri has served as Manager 
of this Department for nearly five 
years. 

The Print Shop made cost trans- 
fers on charges to Hospital Depart- 
ments and to other institutions of over 
$50,000 during the year. These charges 
are computed on cost plus overhead 
basis and are constantly compared with 
the prices of outside printers. In most 
cases, the cost savings are significant, 
in addition to the speed and con- 
venience of printing on the premises. 

Special Services 

The Special Services Department 
assumes the responsibility for security, 
locks and keys, grounds and landscap- 
ing, apartment house management, ele- 
vator operating, truck service, and the 
day-to-day operation of the parking 



lots. Mr. George Nicoll manages this 
Department, and in addition handles 
details of the many parties and events 
that are held at the Hospital during 
the year. Many of these take place on 
our beautiful Prouty Terrace. This 
past year it provided a setting for the 
annual Christmas Tree lighting cere- 
mony, the M.D.C. traveling zoo, the 
Recreation Department's patient art 
festival, the Children's Theatre and the 
Royal Canadian Navy Band, to men- 
tion a few. 

Security in any large metropolitan 
medical center is a continuing responsi- 
bility. A thorough organization and 
cataloging of the locks and keys for 
the entire building has been completed. 
An outside security service is under 
contract to provide trained watchmen 
and guards on duty twenty-four hours 
each day. 

The planned multilevel parking 
garage will be most welcomed and 
should provide relief of the overtaxed 
lots which were used by over 100,000 
patients' parents and visitors during 
the year. 

Communications 

The end of 1962 marked the retire- 
ment of Mrs. Ruth O'Brien as Chief 
Operator after thirty-four years of out- 
standing service to The Children's Hos- 
pital. Mrs. O'Brien saw the Hospital's 
switchboard grow to the point of serv- 
ing over 700 telephones within the 
Hospital and more than 45 outside 
lines. Twelve operators are required to 
provide twenty-four-hour coverage 
seven days per week. 

Late in the year, the New England 
Telephone and Telegraph Company 
sent in a survey team to study our 
entire communications system. It is 
anticipated that during 1963 several 
important changes will be made to 
relieve the load on the operators and 



improve the service. The variety of 
communication equipment that is avail- 
able today is large and needs careful 
analysis by the prospective purchaser 
to assure the best service for the least 



Reception and Messenger Service 

Mrs. Grace Bradley, as Senior Recep- 
tionist, again headed a group of twelve 
receptionists who staffed the four main 
entrance points of the Hospital. Their 
task of greeting and directing patients, 
parents, and visitors is a significant 
one which requires friendliness, under- 
standing, patience, and a thorough 
knowledge of the Hospital. 

The receptionist must receive and 
deliver, with the aid of a group of 
messengers, all of the flowers, gifts, 
telegrams, and registered mail which 
come in daily. In addition, she is re- 
sponsible for the operation of an ex- 
tensive intra-departmental messenger 
service. 

Summary 

It is probable that the most significant 
development affecting the general serv- 
ices area during the past year has been 
the installation of a comprehensive 
wage and salary program throughout 
the Hospital. The careful evaluation of 
all jobs will now make possible an 
equitable distribution of our payroll 
dollar. It will enable us to system- 
atically prepare departmental budgets 
and to measure the operation of our 
departments against similar depart- 
ments in other institutions. 

The general services, with certain 
exceptions, can only reflect the activi- 
ties and demands of the nursing and 
auxiliary departments which they must 
support. They do not initiate costs but 
merely attempt to provide the best 
service for the least cost. 

1963 will find our new depart- 



148 

REPORTS OF ADMINISTRATIVE DEPARTMENTS 



merit heads more familiar with the 
Hospital and the wage and salary pro- 
gram will be in full effect. As a result 
we look forward to major improve- 
ments in our efforts to provide good 
service. 

Rudman J. Ham 
Director of General Services 



149 



DIRECTOR OF NURSING 



REPORT OF 

DIRECTOR OF NURSING 

The years 1961 and 1962 brought into 
sharper focus the effect of some of 
the recent changes in this Institution 
as it has grown in size and multiplied 
its activities. What some had not fully 
foreseen now became clear, namely, 
that the growth of the Institution had 
made obsolete many practices and pro- 
cedures appropriate in the past. This 
has been as true in Nursing as in other 
Departments of the Hospital. 

No Department is more affected 
than is Nursing by changes in Hos- 
pital organization and management 
since nurses are involved, directly or 
indirectly, in almost all Hospital ac- 
tivities. The relationship may not 
bear immediately upon the care of the 
patient as does, for example, food serv- 
ice or the work of the diagnostic de- 
partments, but may be more indirect 
like the activities of the Accounting, 
Maintenance, or Housekeeping Depart- 
ments. In either case, what is done may 
alter or affect nursing activities. 

Thus a decision to institute new 
charges to patients may require the 
Nursing Service to find and train a 
person to carry out this procedure on 
the Divisions; establishment of new 
laundry service or the development of 
new job responsibilities for the maids 
in the Housekeeping Department like- 
wise may call for cooperation in plan- 
ning between Nursing and the other 
Department involved. 

Nursing, therefore, and particu- 
larly the administrative staff, has been 
seriously strained by the many studies 
and the developments in management 
which C. H. M. C. has undertaken in 
the past few years. New methods of 
cost accounting, budgeting and billing, 
the management survey, the establish- 
ment of a central laundry, the develop- 
ment of new personnel policies and 
the Wage and Salary Program, to 
mention only a few, have all required 
senior nursing staff to give much of 
their time to work which seems re- 



mote from the nursing care of pa- 
tients. That the changes are desirable, 
and even essential, is recognized and it 
is obvious that many of them cannot 
be accomplished without nursing co- 
operation; indeed some that were over- 
due will correct problems about which 
the Nursing Department has long been 
concerned, so the opportunity to work 
for improvement has been welcome. 

Much has been accomplished but 
much remains to be done. For the 
Nursing Service, this means continued 
effort to work with Hospital Adminis- 
tration and the various Departments 
while at the same rime making needed 
improvements in the organization of 
the Service itself, which hopefully may 
provide patients with better care. 

Among the improvements which 
are great cause for encouragement are 
the development of personnel policies 
and wage scales which give promise 
of reducing turnover of auxiliary per- 
sonnel, a turnover which unquestion- 
ably has been a cause of inefficiency in 
operation and also of enormous ex- 
pense. The Housekeeping Department 
has been making strides in reallocating 
responsibilities and assuming many of 
those formerly carried by nurses, and 
the development of the central laundry, 
while it has not been without its 
vicissitudes, will provide far better 
service than the old laundry; indeed 
much improvement has already taken 
place. An acute need exists for the 
Dietary Department of the Hospital 
to assume its correct role in patient 
food service. Happily, it appears that 
such a move is not far away. 

Throughout the country, hospital 
administrators and nurses alike now 
recognize that it is imperative to re- 
align tesponsibilities in hospitals so 
that nursing time is not spent on 
activities which others with different 
preparation can do better, or those 
with less preparation can do just as 
well. Thete are several reasons for 



150 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



this conviction of which the overriding 
one is the shortage of registered nurses 
and licensed practical nurses for pa- 
tient care. Another is a matter of hos- 
pital economics, it being less costly to 
assign simple housekeeping tasks to 
persons other than nurses and more 
efficient to engage properly prepared 
employees to do many jobs for which 
nurses are not prepared at all. 

It is a paradox that the supply of 
nurses available to care for patients 
should be so inadequate at a time when 
the number of practicing nurses pro- 
portionate to the population and the 
numbers employed in hospitals are both 
greater than in an earlier day when 
the need seemed less acute. The reasons 
are not far to seek: multiplicity of thera- 
peutic measures and the rapid patient 
turnover, the more complex hospital 
structure and new demands upon 
nurses, the movement of nurses from 
job to job or job to marriage, changes 
in nursing education which reduce stu- 
dent service, shorter working hours for 
all, the gradual acquisition by nurses 
of responsibility for many procedures 
formerly not done or formerly done 
by doctors. All these and many more 
have contributed to increase in de- 
mand for nursing services. That the 
demand will decline in the future or 
the supply increase seems unlikely. It 
is, therefore, all the more important 
that nursing time be used to the best 
advantage. 

As one looks at the development 
of hospitals, a striking feature is the 
degree to which nursing service was 
responsible for much of the manage- 
ment of household services as well as for 
the nursing care of patients. Gradually 
separate departments for these various 
services have developed but in many 
ways it has been difficult to change the 
pattern of nurse responsibility, pardy 
because administrators and doctors did 
not distinguish between nursing care 
and the so-called "hotel-type" functions 



associated with patient hospitalization. 
Part has been the fault of nurses them- 
selves who have been equally confused 
and perhaps also somewhat reluctant to 
relinquish any responsibilities. As a 
consequence the relationship of the 
nurse to the hospital as a whole has 
been quite different from that of the 
physician who comes to see and treat 
his patient, leaving responsibility for 
the environmental factors to others. 

To see all this is easier than to 
change it, for hospitals that have been 
running a long time are steeped in tra- 
dition and, perhaps most important, the 
pace of development of new therapeu- 
tic measures is such as to keep people 
so busy that little time is left for 
planning or for putting necessary 
changes into effect. The great variety 
of people who must come together to 
bring about change in procedure on 
a hospital-wide basis is always con- 
siderable and their meeting difficult to 
arrange. 

If one can imagine a setting in 
which nurses do not have to think 
about the provision of hotel-type serv- 
ices for patients and give their full 
attention to the nursing of patients 
and assisting of doctors with therapy, 
then one has a good objective for the 
future. Some places in the country have 
accomplished much toward such a goal 
but it is not easily done. 

At the time one tries to reallocate 
jobs and make organizational changes 
it is necessary to think through care- 
fully what the effect of such changes 
may be, lest in curing one problem 
a worse be created. With the many 
departments and people involved in 
hospitals there is always the danger 
that the care of the patient will be 
fragmented with no one person able 
to see all that happens to him. As 
one therefore takes away from the 
head nurse the many years' accretion 
of job responsibilities, it is necessary 
to avoid chipping away her authority 



as well, for she is the individual most 
strategically placed to coordinate the 
activities of the various groups who 
serve the patient. She can do a far 
better job if more of her time is de- 
voted to the patient rather than to an- 
cillary matters, provided she retains 
enough authority to act in the best 
interest of the patient as the agent of 
the physician who has established the 
plan of care. This authority can only 
be derived from agreement among 
medical staff, hospital administration, 
and nursing upon what is desired for 
the patient and what the role of the 
head nurse should be. 

The word "communications" has 
been nearly worn out of late, but that 
people feel the need to mention it so 
often does point to changes in our 
society which make it necessary for 
us to tell each other what used to be 
understood without being said. This is 
just as true in a hospital as in any 
other institution; indeed, hospitals may 
be a prime example of the need for 
good communications. Such a need 
has always existed, but it never was as 
acute as it is today when hospital 
people are in danger of diminishing 
the value of the work they do because 
of their inability to find ways to plan 
and work together in the interest of 
the patient. All Departments are in- 
volved, but Medicine, Administration, 
and Nursing have the greatest re- 
sponsibility to provide solutions; fail- 
ure to do so may be tragic in its results. 
Muriel B. Vesey, R.N. 
Director of Nursing 



151 



DIRECTOR OF NURSING 



Nursing Service Staff 






September 30, 1962 




' jll 


Registered Nurses 


170 


Licensed Practical Nurses 


31 


#f 


Aides and Orderlies 


97 


/Of 


Ward Managers 


1 


*z-~ 


Clerical ( Divisions ) 


22 


^\ 


Secretarial 


V/2 


2- 


Total 


3221/2 


w 




152 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



REPORT OF DIRECTOR, 
SCHOOL OF NURSING 

This report for the years 1961 and 
1962 must record a sad event which 
dominated the latter year: the death in 
January 1962 of Miss Theresa Hurley, 
Associate Director of the School of 
Nursing. Miss Hurley had held this 
key position for fourteen years and 
bore a major responsibility for the 
School's various programs. The contri- 
bution she made was recognized in 
resolutions adopted by the Executive 
Committee of the Board of Trustees, 
and by the Alumnae Association of the 
School of Nursing at its annual meet- 
ing. 

A memorial to Miss Hurley, The 
Theresa A. Hurley Memorial Library 
Fund, was established for the purchase 
of books for the School of Nursing 
Library. Many alumnae of the School 
wished to remember Miss Hurley in 
this way or by contributing to the 
scholarship fund of the Alumnae Asso- 
ciation. The library has just purchased, 
with part of these funds, the most re- 
cent edition of the Encyclopedia Bri- 
tannica. 

In May of 1962, Miss Ethel Traf- 
ton, a graduate of The Children's 
Hospital School of Nursing, holding 
the master's degree from Boston Uni- 
versity School of Nursing, was ap- 
pointed Associate Director. Miss 
Trafton has held significant posts, both 
in the Nursing Service and on the 
faculty of the School and has excep- 
tional qualifications for her new re- 
sponsibilities. 

In the fall of 1961, the planning 
for the Harvard Affiliated Hospitals 
quite naturally led to a consideration of 
the feasibility and desirability of a 
centralized plan for nursing education 
and nursing services. Discussions be- 
gun at that time have continued 
throughout the subsequent year. 

Early in 1962 the committee 
recommended the development of pro- 
grams in nursing education, under the 



aegis of a university, to be of different 
lengths, preparing nurses with varying 
degrees of knowledge and skill, and 
allowing for progression from one 
program to another. Such a school 
would utilize the clinical facilities of 
the hospitals associated with Harvard 
Medical School and might eventually 
replace the schools now under control 
of these hospitals. Since the parent 
committee has accepted the nursing 
committee's report, study of ways to 
develop such a plan continues. 

The last few years have seen many 
changes in nursing education, some of 
which have pointed to its eventual 
movement out of hospitals and into 
such educational institutions as junior 
and senior colleges and universities. 
As far back as 1948, the profession 
went on record as favoring such a 
development. 

Aside from the reasons which 
prompted the nursing profession to 
favor collegiate education for profes- 
sional nurses, hospitals also have been 
interested in this trend because of the 
increasing expense which programs of 
nursing education have entailed, ex- 
pense frequently reflected in charges 
to patients, and because the burden of 
preparing the majority of nurses for all 
nursing services in the country has 
fallen upon a relatively small number 
of hospitals, most of them voluntary. 
With patient care costs rising it has 
been natural for boards of trustees to 
question the wisdom of continuing 
schools. But the decision to close is a 
difficult one since there exists the fear 
that the present short supply of regis- 
tered nurses, of whom approximately 
eighty per cent are educated in hospi- 
tals schools, will be further reduced. At 
present, collegiate schools of nursing 
are not numerous enough to fill the 
gap. In spite of these deterrents the 
number of hospital schools declined 
from 1,190 in 1950 to 856 in I960; 



153 



DIRECTOR, SCHOOL OF NURSING 



this decline has accelerated in recent 
years with the establishment of schools 
in both junior and senior colleges. 
Should the public school system be 
extended through the fourteenth year 
it is likely that two-year programs in 
nursing would be developed rather 
rapidly in New England. 

Under these circumstances, inter- 
est in the actual costs of nursing edu- 
cation has become more intense. 
Among efforts to determine these has 
been a study under the auspices of the 
National League for Nursing begun in 
1959 in which The Children's Hospi- 
tal School of Nursing was included. 
The study showed that the total school 
cost, for the fiscal year I960, was $613,- 
021.00 of which $199,452.00 were 
direct costs and $413,569.00 indirect, 
including the cost of maintaining stu- 
dents. Of the total, $258,652.00 is at- 
tributable to The Children's Hospital 
program; the balance is the cost of of- 
fering other programs in nursing of 
children. 

The annual average cost to The 
Children's Hospital Medical Center for 
a student was therefore $2,463.35. Cash 
income from tuition and fees together 
with the estimated value of the stu- 
dents' services incidental to learning to 
care for patients, is estimated to offset 
the expense by $752.55 leaving a de- 
ficit per student of $1,710.80. 

Increases in charges were insti- 
tuted in September 1962 bringing to 
approximately $1,100.00 the fees paid 
by students in three years. It appears 
probable that further increases will be 
necessary in the near future. 

Affiliating schools, which send 
students here for instruction and ex- 
perience in pediatric nursing, have 
been warned of a tuition charge to be 
instituted soon to offset in part a loss 
estimated at $180.00 per student in 
1959-60. Since the School receives be- 
tween five and six hundred such stu- 



dents a year it is evident that the loss 
sustained in offering this program is a 
very sizeable one. 

As might be anticipated, the in- 
crease in charges to students has 
resulted in more frequent requests for 
financial assistance, which heretofore 
had been relatively few. Funds made 
available by the Women's Committee 
and by the Alumnae Association of 
the School of Nursing thus far have 
been adequate to meet the most press- 
ing needs; in the future it is likely 
that further sources of such funds may 
have to be sought. In the last two 
years students received $1,200.00 from 
the Stella Goostray Scholarship Fund 
of the Alumnae Association of the 
School of Nursing and $1,975.00 from 
the Hospital scholarship fund which 
also is authorized to give tuition schol- 
arships to registered nurses on the staff. 

The School continues to receive 
approximately two hundred applica- 
tions and to accept forty-eight candi- 
dates annually; the opportunity for 
selection of well-qualified candidates is 
therefore good. The Admissions Com- 
mittee voted in 1962 to require that 
candidates present the scores of the 
scholastic aptitude test of the College 
Entrance Examination Board as an 
additional measure of suitability for 
entrance to the course. 

Academic aptitude is by no means 
the only criterion for selection of stu- 
dents, but it is necessary that every 
effort be made to enroll those who can 



carry the course successfully; while 
scholastic ability does not ensure 
success in nursing, a reasonable degree 
of such ability is nevertheless sine qua 
non for an acceptable candidate. That 
selection has been satisfactory in this 
respect is evidenced by results of State 
Board Examinations in which the 
classes of I960 and 1961 showed excel- 
lent standing with no failures and with 
average scores exceeding national 
means by a considerable margin. These 
results are given below. 

In 1961, the graduates of this 
School attained an average score in 
nursing of children equalling the high- 
est attained by any school in Massa- 
chusetts, either hospital or college. 

Knowledge and ability to pass 
examinations are not the only consid- 
eration in evaluating nurses. Skills and 
attitudes are equally important, if much 
harder to measure. In this coming year 
we hope to obtain information regard- 
ing the success on the job of recent 
graduates of this School, which is after 
all the real test. 

That selection is far from perfect 
however is evident in withdrawal rates. 
While they usually have been well 
below the national average, which is 
33% for schools of nursing, there are 
times when the rates of withdrawal are 
much higher than one could wish. 
Obviously some individuals are ac- 
cepted who find they are not suited to 
nursing or who, in the faculty's judg- 
ment, do not demonstrate satisfactory 



Class of 1960 (32 members) 










Medical 


Surgical 


Obstetrical 


Pediatric 


Psychiatric 


Nursing 


Nursing 


Nursing 


Nursing 


Nursing 


Average Scores 579.6 


556.2 


565.9 


599.4 


555.5 


National Mean Score . . 542 


518 


528.5 


519.4 


538.2 


Class of 1961 (34 members) 










Average Scores 573 


559.9 


560.7 


627.4 


555.6 


National Mean Scores . 517.7 


517.3 


513.2 


512.2 


522.2 



154 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



ability, whatever their capacity to pass 
the courses may be. In the two years, 
1961 and 1962, the School graduated 
66 candidates of a total intake for 
the two classes of 93, a 29% with- 
drawal In the nine years, 1952-60, 
the average withdrawal rate was 17.9%. 

One internal change in the program 
which has made for more effective in- 
struction and guidance is the employ- 
ment of two instructors who spend all 
their time in the Peter Bent Brigham 
Hospital with the students from this 
School. These nurses are regular faculty 
members of The Children's Hospital 
School of Nursing but aside from par- 
ticipation in faculty activities are at- 
tached to the Brigham at all times. 

At the close of 1962, seventeen 
schools of nursing are sending students 
for the regular affiliation in nursing of 
children. During the preceding two 
years the Salem Hospital School of 
Nursing discontinued its affiliation, 
substituting experiences at the new 
North Shore Babies and Children's 
Hospital, and the Massachusetts Memo- 
rial Hospitals School of Nursing closed. 

Students are received also fron> 
two college schools, theRadcliffe-Massa- 
chusetts General Hospital Coordinated 
Program and Simmons College School 
of Nursing. The Hospital provides 
facilities for these students but is not 
responsible for their program of in- 
struction. In 1962, Boston College 
transferred its students to another in- 
stitution. 

The School of Nursing also takes 
responsibility for instruction and clini- 
cal experience for practical nursing stu- 
dents from the Holy Ghost Hospital 
School of Practical Nursing and from 
the Boston Trade School. At the close 
of the year arrangements are being 
made to receive students from the 
Shepard-Gill School of Practical Nurs- 
ing, formerly the Household Nursing 
Association. It is appropriate that The 



Children's Hospital should have a part 
in the preparation of students from 
this school which bears the names of 
two Children's Hospital graduates, the 
late Mrs. Katherine Shepard Dodge 
and the late Miss Helen Gill. 

The large numbers of students for 
which the School is responsible present 
both faculty and Hospital staff with 
many problems. Qualified faculty mem- 
bers are in short supply so that often 
it is not possible to find experienced 
instructors to fill all the positions. Even 
with full staff the work load of faculty 
members in this institution is very 
heavy; when vacancies occur or posi- 
tions are filled by inexperienced teach- 
ers the additional tasks become truly 
arduous. The School has cause to be 
grateful for the devoted work of the 
faculty group. Gratitude is due also 
to a number who left the staff in the 
past two years, among whom special 
mention should be made of Miss Ruth 
Lumbra, a faculty member for many 
years, who resigned in 1961. Miss 
Lumbra's interest in the students and 
in the School were notable as was her 
ability as a teacher. 

The greatest need in the School is 
for more and better prepared faculty, 
but the lack felt here is far from 
unique; nurses properly qualified to 
teach are in short supply throughout 
the country. Recent improvements in 
personnel policies are helpful in recruit- 
ment and most encouraging. There 
remains, however, concern about a re- 
tirement plan as many of the more 
permanent teachers are acutely con- 
scious of this need. These are the 
teachers who may be qualified for uni- 
versity teaching posts where policies 
offer much more security. Also desir- 
able would be a plan for sabbatical 
leave for faculty. 

Equipment is of less importance 
than people, nevertheless good equip- 
ment helps staff to teach more effec- 



tively. Projection and recording equip- 
ment are among the items the School 
needs. Air conditioning of a classroom 
might appear to be a luxury, but in the 
case of the main lecture room in Gard- 
ner House it now seems to be almost 
a necessity. This small room is filled 
when affiliate classes are of normal size 
and in the summer the heat is trou- 
bling; more serious however is the in- 
creasing noise, especially from aircraft, 
so that in summer when windows are 
open, instructors may be interrupted 
several times during a lecture. 

Finally, teaching and office space, 
especially in the Hospital, is limited 
and real difficulties ensue at times, but 
these are problems common to all de- 
partments, so the School can but accept 
the inconvenience philosophically and 
look forward to improvements in the 
future. 

Muriel B. Vesey, 

Director, School of Nursing. 



155 



DIRECTOR, SCHOOL OF NURSING 



EXHIBIT A 

School of Nursing Statistics 
Students Enrolled 

October 1, I960 112 

September 30, 1962 125 
Students Admitted 94 

Re-admitted 8 

Graduated 63 

Resigned 22 

Off Roll Temporarily 4 

Affiliating Students Enrolled 

October 1, I960 131 

September 30, 1962 121 



Entered 1960-61 
1961-62 



512 
582 



EXHIBIT B 

SCHOOLS AFFILIATING 
AT CLOSE OF 1962 

New England Deaconess Hospital 
School of Nursing 

Eastern Maine General Hospital School 
of Nursing 

Beverly Hospital School of Nursing 

Peter Bent Brigham Hospital School of 
Nursing 

Worcester-Hahnemann Hospital 
School of Nursing 

Quincy City Hospital School of Nurs- 
ing 

Truesdale Hospital School of Nursing 

McLean Hospital School of Nursing 

New England Baptist Hospital School 
of Nursing 

The Faulkner Hospital School of Nurs- 
ing 

Newton-Wellesley Hospital School of 
Nursing 

Concord Hospital School of Nursing 

Mary Hitchcock Memorial Hospital 
School of Nursing 

Melrose- Wakefield Hospital School of 
Nursing 

Beth Israel Hospital School of Nursing 

Leominster Hospital School of Nursing 

Lasell Junior College 



156 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



REPORT OF 

DIRECTOR OF PERSONNEL 



During the period covered by this re- 
port, the Personnel Department has 
made noticeable progress in the field 
of personnel administration and em- 
ployee relations. 

Significant and constructive prog- 
ress has been made in the development 
of a salary administration program. 
With the assistance of a consultant 
from Industrial Relations Counselors 
Service of New York City a formal 
program for administering Hospital 
personnel salaries on a systematic and 
equitable basis has been almost com- 
pleted. Up to the present, salaries have 
been based partially on emotion and 
whim, and consequently have been the 
source of much employee dissatisfac- 
tion. I am confident that the new 
program, when formally established, 
will do much to eliminate the existing 
inequities and contribute materially to 
management effectiveness in a number 
of ways, including: analyzing the 
soundness of the Organization's struc- 
ture; developing an understanding and 
appreciation of the aims and needs of 
each Department; facilitating com- 
munication between the employee and 
his supervisor; providing a basis for 
the selection and placement of per- 
sonnel; and assisting management and 
individuals to control the efforts of the 
Organization to insure a coordinated, 
mutually satisfactory operation. 

I am extremely pleased to report 
that the Executive Committee of the 
Board of Trustees voted to pay the 
entire cost of an employee's individual 
Blue Cross premium. In dollars and 
cents this means that The Children's 
Hospital Medical Center will bear 
about sixty per cent of the individual's 
Blue Cross-Blue Shield premium. This 
is the first Hospital-paid benefit that 
we have been able to offer, and I am 
confident that, as our financial condi- 
tion improves, additional benefits will 
be provided. 



Employee turnover at the Hospital 
continues at a disheartening rate: 
about 72 per cent on an annual basis. 
The following Departments show the 
highest rate of instability: Housekeep- 
ing, 110 per cent; Medical Records, 92 
per cent; and Nursing, 80 per cent. 
During the past year we have hired 
950 new employees, and further scru- 
tiny shows that about 3,000 applicants 
were interviewed to secure these 950. 
Departures from the Nursing Service 
are a constant source of anxiety, even 
though our Nursing pay scale is among 
the best in the Boston area. The fact 
is that the gypsy trait of professional 
nurses seems to be pandemic. Low 
salaries account for the high turnover 
in the other two areas. 

In the general area of personnel 
administration, policies and procedures 
have been established and published 
covering vacations, sick leave, over- 
time, holidays, and terminal pay. It is 
notable that our "Sick Leave" policy 
permits accumulation of sick days at 
the rate of one day per month up to a 
maximum of 180 days. A minimum 
wage of $1.20 per hour was estab- 
lished, effective October 1, 1962. 

Other activities carried out by 
the Personnel Department relate to 
services for employees. The Summer 
Festival was held late in June, with 
over 500 employees participating, and 
was generally considered a smashing 
success. The Service Award Ceremony, 
honoring employees with five or more 
years at The Children's Hospital Medi- 
cal Center, took place in May with Mr. 
Wolbach presenting certificates to the 
most senior employees. The annual 
Christmas Party was held on Decem- 
ber 13th, with the majority of em- 
ployees participating in the festivities. 

A good deal of progress has been 
accomplished over the past year, yet 
much remains to be done in the area 
of personnel administration which, of 
course, contributes to our common goal 
of better child care. 

Alexander T. Brown 
Director of Personnel 



157 



DIRECTOR, VOLUNTEER SERVICE 



REPORT OF DIRECTOR, 
VOLUNTEER SERVICE 

"Good is done by degrees. To do the 
small, the modest thing which lies be- 
fote us, to realize the spiritual irrevo- 
cability of our smallest acts, this is to 
be useful, and the useful and the beau- 
tiful are rarely, if ever separated." 
(Francis J. Braceland, M.D., Sc.D., in 
an address presented at the 1959 meet- 
ing of the American Hospital Asso- 
ciation.) Our "useful" and "beautiful" 
volunteers donated 50,065 hours of 
service in what Albert Schweitzer 
terms "careers of the spirit." 

The Recreation program, which 
now provides service from 9:00 a.m. 
through 8:00 p.m., is staffed by people 
ranging in age from sixteen to "over 
sixty"; by students who apply as individ- 
uals and those who are referred to us by 
State Teachers College, Wheelock Col- 
lege, and Boston Latin School; by busi- 
ness girls; and by an increasing num- 
ber of male students and business men. 

The Recreation Department has 
shown dramatic growth in hours of 
service to the patients. Such growth is 
attributable to several factors. The in- 
creased staff of the Recreation Depart- 
ment, and their interest in training 
and supporting the volunteers, has re- 
sulted in an esprit de corps that has 
done much to eliminate "drop-outs" 
and absenteeism. As each recreation 
teacher is familiar with the patients 
on her floor, the volunteers are di- 
rected to those patients who have the 
greatest need for their services. This 
intelligent direction has increased the 
volunteers' feeling of accomplishment 
and of genuinely being needed. 

A summer evening recreation 
program was pioneered in 1961 hope- 
fully, but dubiously, since it was 
feared that the volunteers would not 
persevere during the sultry nights. The 
Recreation Coordinator and I were 
firmly convinced that the patients' 
needs for such a program were so great 
that it would succeed, and to substan- 



tiate our conviction, worked at night 
to assist with supervision. I have sel- 
dom had more genuine fun, nor 
crawled home more completely ex- 
hausted, than on the nights when, as- 
sisted by members of the Phillips 
Brooks Club of Trinity Church, we 
provided weekly cook-outs for the 
patients at the House of the Good 
Samaritan. All the patients in the 
Respirator Unit were brought out onto 
the first floor porch, where the ham- 
burgers and hot dogs sizzled on a re- 
calcitrant charcoal broiler. The pa- 
tients on Divisions 72, 73, and 74 who, 
for medical reasons, are not permitted 
to mingle with the respirator patients, 
peered through the upper porch rail- 
ing like a group of hungry nestlings, 
impatiently awaiting their dinners, 
which were rushed up over the stairs 
by the volunteers. Visualize, if you 
will, the Babel of cries for rare! me- 
dium! well done! mustard! piccalilli! 
ketchup! etc. etc. 

As always, the bulk of the sum- 
mer volunteers are high school and col- 
lege students. During the summer of 
1962, seventy-three young girls and 
eleven boys worked in excess of 8,000 
hours. Twenty-six of them were 
awarded the American Hospital Asso- 
ciation 100-hour pin. Every Hospital 
Department which is serviced by vol- 
unteers, with the exception of the 
Nurses Aide Service, utilized the teen- 
agers. I cannot speak too highly of 
these fine young people, of their seri- 
ousness of purpose, their application 
to their assigned tasks, and of the 
Staff's appreciation of their work. The 
fifty-eight schools they attended, as far 
west as Ohio, as far south as New 
Orleans, as far north as Canada, and 
as far east as Switzerland, were each 
notified of their students' summer ac- 
tivities. Not only does the Hospital 
receive their services, but the public 
relations potential from such a group, 



158 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



many of whom have written to me 
expressing their gratitude for being 
given the opportunity to be useful, is 
tremendous. Their parents are not 
insensitive to the fact that many have 
received invaluable career guidance 
just by being in the Hospital, or from 
the many Staff members who found 
the time to talk at length with them. 
They too have expressed their appre- 
ciation, via mail and verbally. 

The Volunteer Service Committee 
has continued to provide assistance to 
this Department. The spring parties 
to honor volunteers, planned and or- 
ganized by the committee under the 
able chairmanship of Mrs. Robert B. 
Almy, were very successful means of 
expressing the Hospital's gratitude to 
the volunteers. Dr. Stewart Clifford 
spoke concerning maternal and child 
health in Russia at the 1961 party, 
and Dr. William F. Bernhard told of 
the recent advances in heart surgery 
at the 1962 party. It is interesting to 
note the increasing number of the 
volunteers' husbands who attend the 
parties to avail themselves of the op- 
portunity to hear our eminent doctors 
tell of their work. At the spring 1962 
meeting, the committee recommended 
the purchase of candy stripe pinafores 
for the teen-age girls and suggested 
that a jacket for male volunteers be 
substituted for the armband previously 
worn. Administration approved the 
request and while delivery date was 
despairingly and constantly manana, 
by mid-summer they were finally de- 
livered. In their new garb the young 
people presented a much more pro- 
fessional and attractive appearance. 

The Patient Intramural Transporta- 
tion team has been able to increase its 
service by extending its time on duty 
to 4:00 p.m. during the summer, and 
by instituting a Saturday Morning 
Service which is staffed by students 
from The Beaver Country Day School. 



The recruiting, screening of appli- 
cants, and assignments are handled at 
the school, by a student chairman 
under the direction of the Head of the 
Senior School, as a means of provid- 
ing the students with an opportunity 
for community service. The House in 
The Pines, in Norton, Massachusetts, 
provides two students each Monday 
who work with the Transportation 



team. The girls are driven to and 
from the Hospital by the school sta- 
tion wagon. 

A new Volunteer Service group 
has completed cataloguing Dr. Jane- 
way's Library in the Laboratory Study 
Building, and with the cooperation of 
the Harvard Medical School Library, 
missing volumes were obtained. Those 
missing issues which were not ob- 



October 1, 


I960 through September 


30, 1961 




Present Year 


Previous Year 


SERVICES 


Hours Volunteers 


Hours Volunteers 


Administrative Aides 


1,52914 


1,346 


Admitting Hostesses 


1,359 


1,42134 


Blood Bank 


2131/2 


348?4 


Clinics 


3,0971/2 


2,78114 


Feeding 


1,2101/2 


1,04414 


Gift Shop 


6,663 


6,894Vi 


Good Samaritan 


3,366/2 


3,31714 


Information Desk 


3211/2 


420/2 


Laboratory 


1,263% 


1,32914 


Library, Patient 


1,1903^ 


1,031 


Lunch Shop 


7,707 


7,847 


Medical Library 


529?4 


— 


Parents Teas 


I8O14 


216/2 


Photography 


1571/2 


162 


Plaster Room 


336?4 


57514 


Post Office 


20714 


183/2 


Recreation: 


5,90114 


3,030/2 


Day 2,292^ 






Evening 1,32214 






O.P.D. 953 






Red Cross A&S 145 V2 






Div. 28 1,178 






Red Cross Aides 


722!4 


799 


Surgical Dressings 


595 


953/2 


Transportation 


4,693/4 


4,99314 


Volunteer Aides 


2,40614 


1,964/2 


X-Ray 


25534 


32934 


Xmas Decorations 


116 


75VS 


Public Information 


4514 


— 


Print Shop 


5 


— 


Social Service 


— 


68V7 


Mended Hearts 


— 


114 


Medical Records 


— 


13414 


Totals 


44,380 724 


41,28214 677 


New Volunteers 


•• 





159 



DIRECTOR, VOLUNTEER SERVICE 



tainable ,at the Harvard Library were 
ordered from the publisher. Now that 
the massive cataloguing has been com- 
pleted, the volunteers service the li- 
brary once a week. The same group 
just recently catalogued the small So- 
cial Service Library. 

The Women's Committee has 



provided the funds and the decorator 
to renovate the drab Volunteer Office. 
Mrs. Kirke Neal's plans have become 
a welcome reality. I am more than 
grateful to the Committee for so gen- 
erously providing an attractive area for 
us to work in. Administration has 
made available a generous closet to re- 



place the inadequate clothes closet in 
the Volunteer Office. 

The Coffee Shop closed its doors 
the first of August for reconstruction, 
necessitated by the addition of a Doc- 
tors' Dining Room to the present cafe- 
teria. The many inquiries from per- 
sonnel and parents relating to the re- 



ANNUAL REPORT 
The Children's Hospital Medical Center — Volunteer Service 
October 1, 1961 through September 30, 1962 







Present Year 




Previous Year 


SERVICES 




Hours 


Volunteers 




Hours 


Volunteers 


Administrative Aides 




1,792 






1,529V* 




Admitting Hostesses 




1,404 Vi 






1,359 




Blood Bank 




531 






2131/2 




Clinics 




2.684VS 






3,097/2 




Feeding 




308V* 






1,210/2 




Gift Shop 




6,448 






6,663 




Good Samaritan Clinic* 


2371/2 






3,366Vi 




Information Desk 




299V6 






3211/2 




Laboratory 




7941/2 






1,26334 




Library, Patient 




1,618V* 






1,19034 




Lunch Shop 




6,764 V* 






7,707 




Medical Library 




541V* 






52934 




Parents Teas 




225 






180V* 




Photography 




199 






1571/2 




Plaster Room 




359 






336?4 




Post Office 




191 




1961 


207V* 




Recreation: 




15,592?4 




Recreation Breakdown 


5,901V* 




Day 7,8531/2 




Day 


2,292V* 






Evening 6,43514 




Evening 


1,322V* 






O.P.D. 


559V4 




O.P.D. 


953 - 






Red Cross A&S 


346 




Red Cross A&S 


1451/2 






Div. 28 


3983,4 




Div. 28 


1,178 






Red Cross Aides 




7971/2 






722V* 




Surgical Dressings 




650V* 






595 




Transportation 




5,246 V* 






4,693V* 




Volunteer Aides 




2,730V* 






2,406V* 




X-Ray 




355 






25534 




Public Information 




281/2 






45VS 




Xmas Decorations 




1491/2 






1-16 




Print Shop 




9734 






5 




Mended Hearts 




19?4 
50,065 






— 




Totals 


44,380 




Volunteers 






786 






724 



•Good Samaritan figure of 1960-61 includes those of the Recreation Service which are now tallied with hospital Recreation hours. 



160 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



opening, and the long queues at the 
cafeteria door at the coffee hour and 
lunch period indicated the tremendous 
service supplied by the Coffee Shop 
under its Chairman, Mrs. Samuel Ste- 
vens, and her faithful teams. The Gift 
Shop, while continuing to remain open 
during the construction period, ex- 
perienced a diminishing trade, as the 
Coffee Shop customer is often a Gift 
Shop browser. Now that it is "back 
in business," the Coffee Shop is once 
again providing a both warm and 
friendly place for parents and Hospital 
personnel to relax, and a considerable 
amount of funds for the Hospital. 

The Surgical Dressings Group, 
which has worked in seven different 
locations during its twenty years of 
existence, is to have its work area 
changed again. Despite its nomadic 
existence, it has made 201,669 dress- 
ings this year. The Chairman, Mrs. 
Joel Barnes, supplies material, trains 
workers, and collects the finished dress- 
ings from four church groups. Mrs. 
W. Harry Slade, who is Mrs. Barnes' 
daughter, formed a Surgical Dressings 
group in Duxbury, which has grown 
too large to continue to do its work in 
her home. The group presently meets 
bi-monthly at "Sunlight House," an 
institution for the blind, in Egypt, 
Massachusetts. Mrs. Barnes and Mrs. 
Blake are one of our many mother- 
daughter teams who carry on the tra- 
dition of service through succeeding 
generations. 

During 1961, the Patient's Li- 
brary circulated 3,579 books. This is 
the largest circulation since records 
have been kept ( 1956) . Mrs. Kenneth 
Warren, Chairman, and the Library 
Volunteers have assisted with the or- 
ganization of patient libraries in the 
Children's Heart Hospital, Philadel- 
phia, Pennsylvania, and in the Chil- 
dren's Hospital, Athens, Greece. In 
addition to the 2,539 books printed in 



English, the library has 272 books 
printed in twenty-five foreign lan- 
guages ranging from Icelandic to 
Gujarati. Excess books are donated to 
the Ranfurly Out-Island Libraries in 
the Bahamas. 

I assisted Mrs. Anthony Michaels, 
the Fund Director, at the spring 
Trustees Luncheons, and spoke at sev- 
eral churches and at the Massachusetts 
State Federation of Women's Clubs' 
Hospital Committee. The Hospital 
Committee donated three Mistogen 
Units to Dr. Harry Shwachmarfs 
Department, and the donations of 
money received from the various 
church groups were used to purchase 
washable slippers for the patients at 
the House of the Good Samaritan. 

The attached statistical report in- 
dicates that there are twenty-six cate- 
gories of Volunteer Services. Each 
category contains people and services 
worthy of a separate report, but as 
space does not permit, I will not at- 
tempt at this time to cover them all. I 
would like to note that Mrs. Richard 
Ginsberg, one of our volunteers, pa- 
tiently computes and posts each volun- 
teer's monthly statistical record, and 
compiles a monthly and an annual 
statistical report. To her, a fervent 
thank you. 

I would like to again express my 
deep appreciation to Administration, 
Staff and to the Women's Committee 
for their continued support and as- 
sistance, and to the volunteers who 
make this report necessary and pos- 
sible. 

Mrs. Kathleen Higgins 
Director, Volunteer Services 



THE CHILDREN'S HOSPITAL MEDICAL CENTER